Top

Published in:

01-07-2017 | Scientific Review

Clinical Prediction Rules for Appendicitis in Adults: Which Is Best?

Authors: Malsha Kularatna, Melanie Lauti, Cheyaanthan Haran, Wiremu MacFater, Laila Sheikh, Ying Huang, John McCall, Andrew D. MacCormick

Published in: World Journal of Surgery | Issue 7/2017

Abstract

Background

Clinical prediction rules (CPRs) provide an objective method of assessment in the diagnosis of acute appendicitis. There are a number of available CPRs for the diagnosis of appendicitis, but it is unknown which performs best.

Aim

The aim of this study was to identify what CPRs are available and how they perform when diagnosing appendicitis in adults.

Method

A systematic review was performed in accordance with the PRISMA guidelines. Studies that derived or validated a CPR were included. Their performance was assessed on sensitivity, specificity and area under curve (AUC) values.

Results

Thirty-four articles were included in this review. Of these 12 derived a CPR and 22 validated these CPRs. A narrative analysis was performed as meta-analysis was precluded due to study heterogeneity and quality of included studies. The results from validation studies showed that the overall best performer in terms of sensitivity (92%), specificity (63%) and AUC values (0.84–0.97) was the AIR score but only a limited number of studies investigated at this score. Although the Alvarado and Modified Alvarado scores were the most commonly validated, results from these studies were variable. The Alvarado score outperformed the modified Alvarado score in terms of sensitivity, specificity and AUC values.

Conclusion

There are 12 CPRs available for diagnosis of appendicitis in adults. The AIR score appeared to be the best performer and most pragmatic CPR.

Stephens PL, Mazzucco JJ (1999) Comparison of ultrasound and the Alvarado score for the diagnosis of acute appendicitis. Conn Med 63:137–140PubMed

Laupacis A, Sekar N (1997) Stiell l G. Clinical prediction rules: a review and suggested modifications of methodological standards JAMA 277:488–494PubMed

Wasson JH, Sox HC, Neff RK et al (1985) Clinical prediction rules. N Engl J Med 313:793–799CrossRefPubMed

Ohle R, O’Reilly F, O’Brien KK et al (2011) The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med 9:139CrossRefPubMedPubMedCentral

Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269CrossRefPubMed

McGinn TG, Guyatt GH, Wyer PC et al (2000) Users’ guides to the medical literature: Xxii: how to use articles about clinical decision rules. JAMA 284:79–84CrossRefPubMed

Zhou X-H, Obuchowski NA, McClish DK (2011) Statistical analysis for meta-analysis statistical methods in diagnostic medicine. Wiley, Hoboken, pp 435–448

Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15:557–564CrossRefPubMed

Andersson M, Andersson RE (2008) The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. World J Surg 32:1843–1849. doi:10.1007/s00268-008-9649-y CrossRefPubMed

10.

Andersson M, Ruber M, Ekerfelt C et al (2014) Can new inflammatory markers improve the diagnosis of acute appendicitis? World J Surg 38:2777–2783CrossRefPubMed

11.

Fenyo G (1987) Routine use of a scoring system for decision-making in suspected acute appendicitis in adults. Acta Chirurgica Scandinavica 153:545–551PubMed

12.

Jahn H, Mathiesen FK, Neckelmann K et al (1997) Comparison of clinical judgment and diagnostic ultrasonography in the diagnosis of acute appendicitis: experience with a score-aided diagnosis. Eur J Surg 163:433–443PubMed

13.

Lindberg G, Fenyö G (1988) Algorithmic diagnosis of appendicitis using Bayes’ theorem and logistic regression Bayesian statistics 3:665–668

14.

Sammalkorpi HE, Mentula P, Leppaniemi A (2014) A new adult appendicitis score improves diagnostic accuracy of acute appendicitis—a prospective study. BMC Gastroenterol 14(1):114. doi:10.1186/1471-230X-14-114 CrossRef

15.

Tzanakis NE, Efstathiou SP, Danulidis K et al (2005) A new approach to accurate diagnosis of acute appendicitis. World J Surg 29:1151–1156 (discussion 1157) CrossRefPubMed

16.

van den Broek WT, Bijnen BB, Rijbroek B et al (2002) Scoring and diagnostic laparoscopy for suspected appendicitis. Eur J Surg 168:349–354CrossRefPubMed

17.

Christian F, Christian GP (1992) A simple scoring system to reduce the negative appendicectomy rate. Ann R Coll Surg Engl 74:281–285PubMedPubMedCentral

18.

Goh PL (2010) A simplified appendicitis score in the diagnosis of acute appendicitis. Hong Kong J Emerg Med 17:230–235

19.

Lintula H, Kokki H, Pulkkinen J et al (2010) Diagnostic score in acute appendicitis. validation of a diagnostic score (Lintula score) for adults with suspected appendicitis. Langenbecks Arch Surg 395:495–500CrossRefPubMed

20.

Scott AJ, Mason SE, Arunakirinathan M et al (2015) Risk stratification by the appendicitis inflammatory response score to guide decision-making in patients with suspected appendicitis. Br J Surg 102:563–572CrossRefPubMed

21.

Al-Hashemy AM, Seleem MI (2004) Appraisal of the modified Alvarado score for acute appendicitis in adults. Saudi Med J 25:1229–1231PubMed

22.

Bhattacharjee PK, Chowdhury T, Roy D (2002) Prospective evaluation of modified Alvarado score for diagnosis of acute appendicitis. J Indian Med Assoc 100(310–311):314

23.

Bulus H, Tas A, Morkavuk B et al (2013) Can the efficiency of modified Alvarado scoring system in the diagnosis acute appendicitis be increased with tenesmus? Wien Klin Wochenschr 125:16–20CrossRefPubMed

24.

Gurav P, Hombalkar N, Dhandore P et al (2013) Evaluation of right iliac fossa pain with reference to alvarado score can we prevent unnecessary appendicectomies? JKIMSU 2(2):24–29

25.

Huang TH, Huang YC, Tu CW (2013) Acute appendicitis or not: facts and suggestions to reduce valueless surgery. J Acute Med 3:142–147CrossRef

26.

Kariman H, Shojaee M, Sabzghabaei A et al (2014) Evaluation of the Alvarado score in acute abdominal pain. Ulusal Travma ve Acil Cerrahi Dergisi 20:86–90CrossRefPubMed

27.

Kim K, Rhee JE, Lee CC et al (2008) Impact of helical computed tomography in clinically evident appendicitis. Emerg Med J 25:477–481CrossRefPubMed

28.

Limpawattanasiri C (2011) Alvarado score for the acute appendicitis in a provincial hospital. J Med Assoc Thai 94:441–449PubMed

29.

Malik AA, Wani NA (1998) Continuing diagnostic challenge of acute appendicitis: evaluation through modified Alvarado score. Aust N Z J Surg 68:504–505CrossRefPubMed

30.

Man E, Simonka Z, Varga A et al (2014) Impact of the Alvarado score on the diagnosis of acute appendicitis: comparing clinical judgment, Alvarado score, and a new modified score in suspected appendicitis: a prospective, randomized clinical trial. Surg Endosc 28:2398–2405CrossRefPubMed

31.

Meltzer AC, Baumann BM, Chen EH et al (2013) Poor sensitivity of a modified Alvarado score in adults with suspected appendicitis. Ann Emerg Med 62:126–131CrossRefPubMed

32.

Owen TD, Williams H, Stiff G et al (1992) Evaluation of the Alvarado score in acute appendicitis. J R Soc Med 85:87–88PubMedPubMedCentral

33.

Pouget-Baudry Y, Mucci S, Eyssartier E et al (2010) The use of the Alvarado score in the management of right lower quadrant abdominal pain in the adult. J Visc Surg 147:e40–44CrossRefPubMed

34.

Pruekprasert P, Maipang T, Geater A et al (2004) Accuracy in diagnosis of acute appendicitis by comparing serum C-reactive protein measurements, Alvarado score and clinical impression of surgeons. J Med Assoc Thail 87:296–303

35.

Rodrigues G, Rao A, Khan SA (2006) Evaluation of Alvarado score in acute appendicitis: a prospective study. Internet J Surg 9:1–5

36.

Tade AO (2007) Evaluation of Alvarado score as an admission criterion in patients with suspected diagnosis of acute appendicitis. West Afr J Med 26:210–212PubMed

37.

Yuksel Y, Dinc B, Yuksel D et al (2014) How reliable is the Alvarado score in acute appendicitis? Ulusal Travma ve Acil Cerrahi Dergisi 20:12–18CrossRefPubMed

38.

Erdem H, Cetinkunar S, Das K et al (2013) Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis scores for diagnosis of acute appendicitis. World J Gastroenterol 19:9057–9062CrossRefPubMedPubMedCentral

39.

de Castro SM, Unlu C, Steller EP et al (2012) Evaluation of the appendicitis inflammatory response score for patients with acute appendicitis [Erratum appears in World J Surg. 2012 Sep; 36(9):2271]. World J Surg 36:1540–1545CrossRefPubMedPubMedCentral

40.

Kollar D, McCartan DP, Bourke M et al (2015) Predicting acute appendicitis? A comparison of the Alvarado score, the Appendicitis Inflammatory Response Score and clinical assessment [Erratum appears in World J Surg. 2015 Jan; 39(1):112; PMID: 25315090]. World J Surg 39:104–109CrossRefPubMed

41.

Kalan M, Talbot D, Cunliffe WJ et al (1994) Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Engl 76:418–419PubMedPubMedCentral

42.

Zhou X-H, Obuchowski NA, McClish DK (2011) Regression analysis for independent ROC data statistical methods in diagnostic medicine. Wiley, Hoboken, pp 261–296

43.

Zhou X-H, Obuchowski NA, McClish DK (2011) Analysis of multiple reader and/or multiple test studies statistical methods in diagnostic medicine. Wiley, Hoboken, pp 297–328

44.

Beasly SW (2000) Can we improve diagnosis of acute appendicitis? BMJ 321:907–908CrossRefPubMed

45.

Abou Merhi B, Khalil M, Daoud N (2014) Comparison of Alvarado score evaluation and clinical judgment in acute appendicitis. Med Arh 68:10–13CrossRef

46.

Kasimov RR, Mukhin AS (2013) Current state of acute appendicitis diagnosis. Sovremennye Tehnologii v Medicine 5:112–116

47.

Wagner JM, McKinney WP, Carpenter JL (1996) Does this patient have appendicitis? JAMA 276:1589–1594CrossRefPubMed

48.

Yegane R, Peyvandi H, Hajinasrollah E et al (2008) Evaluation of the modified Alvarado score in acute appendicitis among iranian patients. Acta Medica Iranica 46:501–506

49.

D’Souza C, Martis J, Vaidyanathan V (2013) Diagnostic efficacy of modified alvarado score over graded compression ultrasonography Nitte University. J Health Sci 3:105–108

Title: Clinical Prediction Rules for Appendicitis in Adults: Which Is Best?
Authors: Malsha Kularatna
Melanie Lauti
Cheyaanthan Haran
Wiremu MacFater
Laila Sheikh
Ying Huang
John McCall
Andrew D. MacCormick
Publication date: 01-07-2017
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 7/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-3926-6

At a glance: The STEP trials

Springer Medicine

Clinical Prediction Rules for Appendicitis in Adults: Which Is Best?

Abstract

Background

Aim

Method

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Aim

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2017

Evaluation of Gastroesophageal Reflux Disease

The Influence of Clinical and Patient-Reported Outcomes on Post-surgery Satisfaction in Cholecystectomy Patients

The Effect of Three-Dimensional Preoperative Simulation on Liver Surgery

Derivation and Validation of a Novel Physiological Emergency Surgery Acuity Score (PESAS)

Primary Surgery for Malignant Large Bowel Obstruction: Postoperative Nasogastric Tube Reinsertion is Not Mandatory

Combined Preoperative Portal and Hepatic Vein Embolization (Biembolization) to Improve Liver Regeneration Before Major Liver Resection: A Preliminary Report