The validity and utility of combining ultrasonography with different clinical scores in diagnosis of acute appendicitis

Authors

  • Ritika Agarwal Department of Radiodiagnosis, Kasturba Medical College, Mangalore, Karnataka, India
  • Abhinav Agarwal Department of Surgery, Maharaja Agrasen Medical College, Agroha, Haryana, India
  • Ashvini Kumar Department of Radiodiagnosis, Kasturba Medical College, Mangalore, Karnataka, India
  • Mukesh Kumar Department of Surgery, Chandra Laxmi Hospital, Ghaziabad, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20191131

Keywords:

Modified Alvarado scoring system, RIPASA, Appendicitis inflammatory response score, Ultrasonography, Appendicitis

Abstract

Background: There are no controlled studies combining the use of either of the scores- Modified Alvarado, RIPASA or AIRS with ultrasonography. This study was conducted to evaluate the diagnostic accuracy of the existent clinical scoring systems in combination with ultrasound imaging in the diagnosis of acute appendicitis in our patients.

Methods: All patients with clinical diagnosis of acute appendicitis and who underwent emergency appendectomy were included in the study. A detailed history of presenting illness was elicited and clinical examination, relevant blood investigations and abdominal ultrasonography were done. All patients were scored according to MAS, RIPASA and AIRS. Histopathology was taken as the gold standard.

Results: The study included 118 patients. From our study population, 107 had acute appendicitis on histopathology. There was no statistically significant difference between the accuracy of MAS and RIPASA and both were equally good in diagnosing acute appendicitis as far as the diagnostic accuracy is concerned. Combined MAS, Combined RIPASA and Combined AIRS were obtained after combining ultrasonography findings with MAS, RIPASA score and AIRS respectively. The diagnostic accuracy, sensitivity, specificity, PPV and NPV for Combined MAS were 96.6%, 99.1%, 72.7%, 97.2% and 88.9% respectively, for combined RIPASA were 95.8%, 99.1%, 63.6%, 96.4% and 87.5% respectively and for combined AIRS was 96.6%, 99.1%,72.7%, 97.2%, 88.9% respectively.

Conclusions: If ultrasonography is used in conjunction with current clinical scoring systems then the diagnostic accuracy is enhanced. Therefore, USG should be done in all cases being evaluated for acute appendicitis; irrespective of the score being used.

Author Biography

Ritika Agarwal, Department of Radiodiagnosis, Kasturba Medical College, Mangalore, Karnataka, India

Department of Radiodiagnosis 

Kasturba Medical College

References

Wilcox RT, Traverso LW. Have the evaluation and treatment of acute appendicitis changed with new technology? Surg Clin North Am. 1997;77(6):1355–70.

Kalan M, Talbot D, Cunliffe WJ, Rich AJ. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Engl. 1994;76(6):418-9.

Chong CF, Adi MIW, Thien A, Suyoi A, Mackie AJ, Tin AS, et al. Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Med J. 2010;51(3):220-5.

Andersson M, Andersson RE. The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. World J Surg. 2008;32(8):1843-9.

Puylaert JB. Acute appendicitis: US evaluation using graded compression. Radiology. 1986;158(2):355-60.

Balthazar EJ, Megibow AJ, Siegel SE, Birnbaum BA. Appendicitis: prospective evaluation with high-resolution CT. Radiology. 1991;180(1):21-4.

Nitta N, Takahashi M, Furukawa A, Murata K, Mori M, Fukushima M. MR imaging of the normal appendix and acute appendicitis. J Magn Reson Imaging. 2005;21(2):156-65.

Orr RK, Porter D, Hartman D. Ultrasonography to Evaluate Adults for Appendicitis: Decision Making Based on Meta-analysis and Probabilistic Reasoning. Acad Emerg Med. 1995;2(7):644-50.

Waris S, Munir A. Modified alvarado score accuracy in diagnosis of acute appendicitis in adults. Professional Med J Dec. 2010;17(4):546-50.

Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910–25.

De Castro SMM, Unlu C, Steller EP, van Wagensveld BA, Vrouenraets BC. Evaluation of the Appendicitis Inflammatory Response Score for Patients with Acute Appendicitis. World J Surg. 2012;36(7):1540-5.

Jones MW, Paterson AG. The correlation between gross appearance of the appendix at appendicectomy and histological examination. Ann R Coll Surg Engl. 1988;70(2):93-4.

Applegate KE, Sivit CJ, Salvator AE, Borisa VJ, Dudgeon DL, Stallion AE, et al. Effect of cross-sectional imaging on negative appendectomy and perforation rates in children. Radiology. 2001;220(1):103-7.

Körner H, Söndenaa K, Söreide JA, Nysted A, Vatten L. The history is important in patients with suspected acute appendicitis. Dig Surg. 2000;17(4):364-8.

Andersson REB. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004;91(1):28-37.

Gronroos JM, Gronroos P. Leucocyte count and C-reactive protein in the diagnosis of acute appendicitis. Br J Surg. 1999;86:501-4.

Kanumba ES, Mabula JB, Rambau P, Chalya PL. Modified Alvarado Scoring System as a diagnostic tool for Acute Appendicitis at Bugando Medical Centre, Mwanza, Tanzania. BMC Surg. 2011;11(1):4.

Macklin CP, Radcliffe GS, Merei JM, Stringer MD. A prospective evaluation of the modified Alvarado score for acute appendicitis in children. Ann R Coll Surg Engl. 1997;79(3):203-5.

Chong CF, Thien A, Mackie AJ, Tin AS, Tripathi S, Ahmad MA, et al. Comparison of RIPASA and Alvarado scores for the diagnosis of acute appendicitis. Singapore Med J. 2011:52(5):340–5.

Douglas CD, Macpherson NE, Davidson PM, Gani JS. Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. BMJ. 2000;321(7266):919.

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.

Flum DR, McClure TD, Morris A, Koepsell T. Misdiagnosis of Appendicitis and the Use of Diagnostic Imaging. J Am Coll Surgeons. 2005;201(6):933-9.

Incesu L, Coskun A, Selcuk MB, Akan H, Sozubir S, Bernay F. Acute appendicitis: MR imaging and sonographic correlation. AJR Am J Roentgenol. 1997;168(3):669-74.

Dsouza C, Martis J, Vaidyanathan V. Diagnostic efficacy of modified alvarado score over graded compression ultrasonography. NUJHS. 2013;3(3):23.

Escribá A, Gamell AM, Fernández Y, Quintillá JM, Cubells CL. Prospective validation of two systems of classification for the diagnosis of acute appendicitis. Pediatr Emerg Care. 2011;27(3):165-9.

Galindo Gallego M, Fadrique B, Nieto MA, Calleja S, Fernández-Aceñero MJ, Ais G, et al. Evaluation of ultrasonography and clinical diagnostic scoring in suspected appendicitis. Br J Surg. 1998;85(1):37–40.

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Published

2019-03-26

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Original Research Articles