Diagnosis and management of acute appendicitis by Alvarado scoring with ultrasonography as supportive tool
DOI:
https://doi.org/10.18203/2349-2902.isj20173423Keywords:
Alvarado score, Acute appendicitis, Histopathology, UltrasonographyAbstract
Background: Acute appendicitis remains as one of the most common surgical entity requiring early intervention. Delay in management results in complications and misdiagnosis results in negative appendectomy. Hence there is always a need to develop a well-designed protocol for diagnosis and to reduce negative appendectomy. Alvarado score for diagnosis of acute appendicitis is an easy, affordable and diagnostic which has been evaluated early with variable reports. In cases with equivocal score, additional tools like sonography may provide a reliable result in accurate diagnosis of acute appendicitis. Objective of the study was to determine the diagnostic accuracy of Alvarado score and ultrasonography in diagnosis of acute appendicitis. To determine the sensitivity, specificity and predictive values of ultrasonography in cases operated with histopathological correlation.
Methods: A prospective observational study was conducted at our hospital by department of general surgery for a period of six months. All suspected cases of appendicitis were scored by Alvarado score and cases with>5 were performed additional USG for further evaluation. All the cases of appendicitis that underwent surgery were further confirmed by histopathological correlation with USG and clinical Alvarado score.
Results: A total of 200 cases were enrolled with male predominance (57.5%) and mean age of study group was 34.26±8.64 years and male to female ratio of 1.3:1.69% of cases presented with Alvarado score of 7 and above, while 21% of cases with 5-6. Migratory pain in RIF was the commonest symptom and tenderness RIF was the most common sign.160 cases (80%) were operated totally with 75% cases lap appendectomy and 25% cases by open appendectomy. USG was performed on 160 cases and 146 were positive and 14 were negative whereas histopathologically 142 cases were confirmed as Acute appendicitis. The sensitivity, specificity, PPV and NPV of USG is 97.18%, 55.56%, 94.52% and 71.43%. The accuracy of USG is 92.5.
Conclusions: Acute appendicitis is first and foremost a clinical diagnosis with scoring systems and imaging being necessary adjuncts in equivocal cases. USG is an easily available tool in diagnosis of acute appendicitis. Application of USG as adjunct tool to Alvarado scoring improves the diagnostic accuracy.
Metrics
References
Kamran H, Naveed D, Nazir A, Hameed M, Ahmad M, Khan U. Role of total leukocyte count in diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad. 2008;20:70-1.
Chan I, Bicknell SG, Graham M. Utility and diagnostic accuracy of sonography in detecting appendicitis in a community hospital. AJR Am J Roentgenol. 2005;184(6):1809-12.
Ohmann C, Yang Q, Franke C. Diagnostic scores for acute appendicitis. Eur J Surg. 1995;161:27381.
Macklin CP, Radcliffe GS, Merei JM, Stringer MD. Prospective evaluations of the modified Alvarado score for acute appendicitis in children. Ann R Coll Surg Engl. 1997;79:2035.
Shafi SM, Afsheen M, Reshi FA. Total leukocyte count, creative protein and neutrophil count: diagnostic aid in acute appendicitis. Saudi J Gastroenterol. 2009;15:117-20.
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emg Med. 1986;15:557-64.
Owen TD, William H, Stiff G, Jenkusion LR, Rees Bl. Evaluation of Alvarado score in acute appendicitis. J Roy Soc Med. 1992;85:87-8.
Horzic M, Salamon A, Koplijar M, Skupnjak M, Ćupurdija K, Vanjak D. Analysis of scores in diagnosis of acute appendicitis in women. Coll Anropol. 2005;29:133-8.
Incesu L, Coskun A, Selcuk MB, Akan H, Sozubir S, Bernay F. Acute appendicitis: MR imaging and sonographic correlation. Am J Roentgenol. 1997;168:669-74.
Siddiqui ZR, Khaliq T, Shah SA. A new simple scoring system for the diagnosis of acute appendicitis. J Pak Med Stud. 2011;1:32-7.
Khan I, Rehman A. Application of Alvarado score in the diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad. 2005;17:41-4.
Almulbim ARS, Al-Sultan AI. Modified Alvarado score for acute appendicitis in overweight patients. Saudi Med J. 2008;29-1184-7.
Talukder DB, Siddiq AKMZ. Modified Alvarado scoring system in the diagnosis of acute appendicitis. JAFMC Bangladesh. 2009;5:18-20.
Paterson HM, Qadan M, De Luca SM, Nixon SJ, Paterson‐Brown S. Changing trends in surgery for acute appendicitis. British J Surg. 2008;95(3):363-8.
Nasiri S, Mohebbi F, Sodagari N, Hedayat A. Diagnostic values of ultrasound and the modified Alvarado scoring system in acute appendicitis. Int J Emerg Med. 2012;5(1):26.
Singh CA, Singh AP, Sajith BSM, Gaharwar APS. Role of Alvarado score in diagnosis and management of acute appendicitis. Int J Sci Stud. 2016;4(6):173-7.
Cobben LP, De Van Otterloo AM, Puylaert JB. Spontaneously resolving appendicitis: frequency and natural history in 60 patients. Radiol. 2000;215:349-52.
Schuh S, Chan K, Langer JC, Kulik D, Preto‐Zamperlini M, Aswad NA. Properties of serial ultrasound clinical diagnostic pathway in suspected appendicitis and related computed tomography use. Academic Emerg Med. 2015;22(4):406-14.
Aspelund G, Fingeret A, Gross E, Kessler D, Keung C, Thirumoorthi A, et al. Ultrasonography/MRI versus CT for diagnosing appendicitis. Pedia. 2014;133(4):586-93.
Azizi R, Farsi N, Motevasseli T, Fereshtehnejad SM, Khatami A. Low diagnostic values of ultrasonography and negative appendectomy: still a major problem in university Hospitals. Med J Islam Republic Iran. 2011;24(4):200-7.
Reddy GVB, VV Subramanyam, B Veersalingam, Sateesh S, Bangla G, Rao PS. Role of Alvarado score in the diagnosis of acute appendicitis. Int J Res Med Sci. 2013;1:404-8.
Gwynn LK. The diagnosis of acute appendicitis: clinical assessment versus computed tomography evaluation. JEM. 2001;21:119-23.
Downloads
Published
How to Cite
Issue
Section
