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Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn. A Systematic Review and Meta-Analysis of the Alvarado Score in Predicting Acute Appendicitis Ohle R, O’Reilly F, O’Brien KK, Dimitrov BD, Fahey T. Alvarado score. 1-4. 5-6. 7-10. Discharge. Observation. Surgery.

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Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

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  1. Royal College of Surgeons in IrelandColáiste Ríoga na Máinleá in Éirinn A Systematic Review and Meta-Analysis of the Alvarado Score in Predicting Acute Appendicitis Ohle R, O’Reilly F, O’Brien KK, Dimitrov BD, Fahey T.

  2. Alvarado score 1-4 5-6 7-10 Discharge Observation Surgery

  3. Objectives of systematic review 1. Meta-analysis of validation studies using the Alvarado CPR to determine its performance in predicting appendicitis 2. Estimate the diagnostic performance of the Alvarado CPR both as an admission criterion and a surgical criterion

  4. Methods

  5. Validation of the Alvarado score Based on the 1986 Alvarado et al derivation study Number predicted by the Alvarado score to have appendicitis Number of observed to have appendicitis in each study Pooled results are presented as risk ratios(RR) RR>1 overprediction RR<1 underprediction by the rule RR=1 predicted equalsobserved Review manager 5 (cochrane collaboration) Mantel Haenszel random effects model

  6. Diagnostic performance Data was extracted and 2x2 tables constructed for : low risk of appendicitis (1-4, 5-10) high risk (1-6,7-10) Men children, and women Results presented sensitivity & specificity with +/- likelihood ratios STATA software Ver.9 (mentandi command)

  7. Search strategy Medline,Embase,Chochrane,DARE Keyword search appendicitis[MeSH] , ‘alvarad*’ , ‘alvorad*’ , ‘Mantrels’ , ‘score*’, ‘index’, ‘system’ and ‘criteria’

  8. Results

  9. 1. Validation

  10. Low Risk (1-4)

  11. Intermediate Risk (5-6)

  12. High Risk (7-10)

  13. 2. Diagnostic Performance

  14. Admission Criterion : ≥ 5

  15. Surgical Criterion : ≥ 7

  16. Conclusion

  17. The Alvarado score is a useful diagnostic CPR for men and children Application in women systematically over-predicts the probability of appendicitis Alvarado is useful as a criterion to “rule out” appendicitis in all patient groups Further diagnostic testing is needed prior to proceeding to surgery in high risk patients

  18. Clinical impact Reduce the number of unnecessary admissions Criteria for communication between surgeon and emergency department physician Reduce the number of unnecessary CT scans and thus reduce the time to operation In areas with no access to further imaging reduce the number of negative appendicectomy

  19. Clinical Pathway Alvarado Score 1-4 5-6 7-10 Discharge Observation/ Investigation Surgical consult

  20. Acknowledgements • HRB centre for Primary Care Research • Prof. T. Fahy • Kirsty O’ Brien • Borislav Dimitrov • Grainne Cousins • Conor Teljeur

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