Akut apandisit tanısında orijinal Alvarado skorlama sistemi: Kohort çalışma.

Year 2017, , 28 - 31, 27.08.2017

Yahya Kemal Çalışkan

https://doi.org/10.28982/josam.342221

Cited By: 4

Abstract

Amaç: Akut apandisit
en sık görülen akut karın nedeni olmasına rağmen hala kesin tanı koyduran bir
yöntem mevcut değildir. Literatürde çeşitli skorlamalar tanımlanmıştır. Bu
çalışmada tanıyı desteklemek amaçlı, bir klinik skorlama sistemi olan Alvarado
skorununun etkinliği araştırdık.

Yöntem: Hastanemiz
acil cerrahi servisinde akut karın ve akut apandisit ön tanısı ile ameliyat
edilecek hastalara, ameliyat öncesinde Alvarado skorları hesaplandı. Bu skor sistem
içerisinde 8 parametre bulunmaktadır. 1-Ağrının sağ alt kadrana göçü,
2-İştahsızlık, 3-Bulantı-kusma, 4-Sağ alt kadranda hassasiyet, 5-Rebound
hassasiyet, 6-Ateş, 7-Lökositoz, 8-Sola kayma (granülositoz). 4 ve 7 numara 2
puan diğerleri 1 puan olmak üzere toplam 10 puan üzerinden hesaplanır.

Bulgular: Toplam 200
hasta, (128 erkek, 82 bayan, erkek/bayan:1.6) ortalama yaş 34.3±15.6, yaş aralığının
15-78 olduğu görüldü. ROC analizinde 6’nın üzerindeki Alvarado skorlarının %76
sensitivite, %91 spesifisite ile akut apandisit tanısını gösterebileceği
saptandı. Alvarado skoru 9-10 %100 sensitivite ile akut apandisiti tespit etti.

Sonuçlar: Akut apandisit
tanısında klinik skorlama sistemleri sık kullanılmaktadır. Alvarado skorlama
sistemini kapsayan yayınlarda 9-10 arası yüksek ihtimal apandisit (cerrahi
girişim), 7-8 arası değerler için ileri tetkik yöntemleri önerilmiştir. Çalışmamızda
literatürle uyumlu sonuçlanmıştır.

Keywords

Akut apandisit, Skorlama sistemleri, Alvarado skoru

Original Alvarado scoring system in the diagnosis of acute appendicitis: A cohort study.

Abstract

Aims: Although acute appendicitis is the most common cause of acute
abdomen, there is still no definitive diagnostic method. Various scores were
defined in the literature. In this study, we investigated the effectiveness of
the Alvarado score, a clinical scoring system aimed at supporting the
diagnosis.

Methods: Patients who were to be operated with acute abdomen and acute
appendicitis pre-diagnosis in our hospital emergency surgery service were
calculated before the Alvarado scores. This score has 8 parameters in the
system. 1-The right lower quadrant of pain, 2-anorexia, 3-nausea-vomiting,
4-right lower quadrant sensitivity, 5-rebound sensitivity, 6-fever,
7-leukocytosis, 8-left shift (granulocytosis). Numbers 4 and 7 are calculated
with a total of 10 points, 2 points, 1 point.

Results: Total 200 patients, (128 males, 82 female, male/female: 1.6)
mean age was 34.3 ± 15.6, and the age range was 15-78. In ROC analysis,
Alvarado scores greater than 6 has demonstrated acute appendicitis diagnosis
with 76% sensitivity and 91% specificity. Alvarado score of 9-10 showed 100%
sensitivity to detect acute appendicitis.

Conclusions: Clinical scoring systems are frequently used in the
diagnosis of acute appendicitis. In publications covering the Alvarado scores
of 9-10, the high probability of appendicitis, needs surgical intervention, and
advanced examination methods were proposed in scores of 7-8. Our study resulted
in consistent with the literature.

Keywords

Acute appendicitis, Scoring systems, Alvarado score

References

• 1. Peterson MC, Holbrook JH, Hales D, Smith, NL, Staker, LV. Contributions of history, physical examination and laboratory investigations in making medical diagnosis. West J Med 1992;156:163-5.
• 2. Anderson RE, Hugander A, Thulin AJ. Diagnostic accuracy and perforation rate in appendicitis: Association with age and sex of the patient and with appendectomy rate. Eur J Surg 1992; 158: 37-41.
• 3. John H, Mathiessen FK, Neckelmann K, Hovendal CP, Bellstorm T, Gottrup F. Comparison of clinic judgment and diagnostic ultrasonography in the diagnosis of acute appendicitis experience with a score-aided diagnosis. Eur J Surg 1997;163:433-443.
• 4. Steven LL, Alicia JW, Hung SH. Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. Arch Surg 2001;136: 556-562.
• 5. Colson M, Skinner KA, Dunnignton G. High negative appendectomy rates are no longer acceptable. Am J Surg 1997;174:723-6.
• 6. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986 May;15(5):557-64.
• 7. Augustin G, Majerovic M. Non-obstetrical acute abdomen during pregnancy. Eur J Obstet Gynecol Reprod Biol 2007;131:4-12.
• 8. Selçuk S. Ruptured heterotopic pregnancy: Case report. J Surg Med. 2017;1:15-17.
• 9. Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: Computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med 2004; 141: 537-546.
• 10. Vidmar D, Omejc M, Cerar A, Makiar J, Repse S. Influence of ultrasonography on clinical decision making in suspected acute appendicitis in adults. Eur Surg 2006; 38: 445–450.
• 11. Maroju NK, Robinson Smile S, Sistla SC, Narasimhan R, Sahai A. Delay in surgery for acute appendicitis. ANZ J Surg 2004;74:773-6.
• 12. Rastović P, Trninić Z, Galić G, Brekalo Z, Lesko J, Pavlović M. Accuracy of Modified Alvarado Score, Eskelinen Score and Ohmann Score in Diagnosing Acute Appendicitis. Psychiatr Danub 2017;29:134-141.
• 13. Singla A, Singla S, Singh M, Singla D. A comparison between modified Alvarado score and RIPASA score in the diagnosis of acute appendicitis. Updates Surg 2016;68:351-355.
• 14. Bergeron E. Clinical judgement remains of great value in the diagnosis of acute appendicitis. J Can Chir 2006;49:96-100.