title: The predictive value of Alvarado score, inflammatory parameters and ultrasound imaging in the diagnosis of acute appendicitis.
abstract: OBJECTIVE
  Acute appendicitis (AA) is one of the most common surgical emergencies. Despite extraordinary advances in modern investigations, the accurate diagnosis of AA remains an enigmatic challenge. The aim of this study was to compare and evaluate the diagnostic accuracy of inflammatory parameters [C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR)], ultrasound (US) and Alvarado score (AS) in reducing the rate of negative appendectomies.
  
  
  METHODS
  Two hundred seventy-eight patients were included in this study. Patients were separated into two main groups as the surgery group (n=184) and non-operative group (n=94). Complete blood count, ESR and PCT levels were assessed, abdominal US was performed and AS was calculated for all patients.
  
  
  RESULTS
  In the surgery group, clinical predictive factors for histopathologic results such as AS ≥7, AA signs on US, neutrophilia and leukocytosis were significant. Neutrophilia and leukocytosis had the highest accuracy rate among these factors. Inflammatory parameters were not predictive for histopathologic results, although higher CRP and PCT levels were significant in perforated and necrotizing appendicitis. Multifactorial regression analyses showed that AS was not of significant predictive value in the non-operative group.
  
  
  CONCLUSIONS
  There was no superiority of AS and/or US in the diagnosis of AA. Recent findings have shown the most reliable parameters in the diagnosis of AA to be primarily 'neutrophilia' and secondarily 'leukocytosis'. Other results of this study indicated that inflammatory parameters (CRP, PCT, ESR) were not superior to other parameters but CRP and PCT levels were significantly high in complicated cases.
authors.affiliation: Department of Emergency Medicine, Bülent Ecevit University School of Medicine, Zonguldak, Turkey.
authors.forename: Ceren Şen
authors.initials: CŞ
authors.lastname: Tanrıkulu
authors.affiliation: Department of Emergency Medicine, Gazi University School of Medicine, Ankara, Turkey.
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Karamercan
authors.affiliation: Clinic of General Surgery, Zonguldak Atatürk State Hospital, Zonguldak, Turkey.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Tanrıkulu
authors.affiliation: Clinic of Emergency Medicine, Ankara Training and Research Hospital, Ankara, Turkey.
authors.forename: Miraç
authors.initials: M
authors.lastname: Öztürk
authors.affiliation: Clinic of Emergency Medicine, Ankara Training and Research Hospital, Ankara, Turkey.
authors.forename: Yücel
authors.initials: Y
authors.lastname: Yüzbaşıoğlu
authors.affiliation: Clinic of Emergency Medicine, Ankara Training and Research Hospital, Ankara, Turkey.
authors.forename: Figen
authors.initials: F
authors.lastname: Coşkun
keywords: Alvarado score; C-reactive protein; acute appendicitis; ultrasound