BACKGROUND/AIMS: Though acute appendicitis is one of the most common surgical conditions, the diagnosis in patients with equivocal signs can be difficult. Many patients with suspected appendicitis are admitted for observation. We designed this study to investigate whether the Alvarado score can be used as an admission criterion. METHODS: This is a prospective study comprising consecutive patients who attended the emergency room with right lower abdominal pain from January 2007 to March 2007. Patients were scored with the Alvarado score and if they were admitted, had a second scoring in the ward. Patients who were not admitted were told to attend the clinic the next day and patients who did not attend the clinic were interviewed by telephone. RESULTS: Total of 132 patients (M=83, F=49) were included and 105 patients were admitted for observation. Eighty-seven patients had surgery with the intention to treat appendicitis and 10 patients did not have appendicitis. The diagnosis of acute appendicitis was highly accurate for an Alvarado score above 6 (90.9%). Patients with a score 4 or less in the ward as well as in the emergency room did not have appendicitis. Of the patients with appendicitis, 49% (38/77) had higher scores in the ward than initial score at the emergency room. CONCLUSIONS: None of the patients with a score of 4 or less had appendicitis. They did not need admission. The Alvarado score can be used as an admission criterion in patients with suspected appendicitis.
Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Appendectomy ; Appendicitis/*diagnosis/surgery ; Child ; Child, Preschool ; Diagnosis, Differential ; Emergency Service, Hospital ; Female ; Humans ; Male ; Middle Aged ; Patient Admission/standards ; Sensitivity and Specificity ; Severity of Illness Index

BACKGROUND/AIMS: Hood cap-assisted chromocolonoscopy using indigocarmine is expected to improve the detection rate of colorectal polyps, especially adenomatous polyps. Therefore, aim of the present study was to evaluate the usefulness of hood cap-assisted chromocolonoscopy in routine colonoscopic examinations. METHODS: From January, 2013 through March, 2013, a total of 86 patients were enrolled (M:F=33:53, mean age=60 years). For each patient, hood cap-assisted colonoscopic examination was performed, followed by hood cap-assisted chromocolonoscopy using 0.2% indigocarmine from the cecum to the hepatic flexure. Total numbers and characteristics of polyps were compared before and after indigo carmine dye spraying. RESULTS: Prior to dye spraying, 48 polyps were found in 37 patients, and after dye spraying, 53 additional polyps were found in 34 patients. Of these undetected polyps, 45 (85%) were small sized polyps (< or =0.5 cm). Histologically, 19 (36%) were adenomatous polyps, and of these, 15 (28%) were tubular adenomas and 4 (8%) were serrated adenomas. As for the polyp detection rate, there was no difference between the expert and the non-expert groups. CONCLUSION: Hood cap-assisted chromocolonoscopic examination using indigocarmine was helpful in detecting cecum and ascending colon polyps, especially small sized polyps (<0.5 cm) and neoplastic polyps.
Adenoma ; Adenomatous Polyps ; Cecum ; Colon, Ascending ; Colonoscopy ; Humans ; Indigo Carmine ; Polyps*