Evaluation of modified Alvarado scoring system in diagnosis of acute appendicitis - a prospective study
Keywords:Modified alvarado score, Usg - ultrasonography
Background:The most frequently encountered complaint which is a surgical emergency also is pain in abdomen and under this spectrum falls pain of acute appendicitis, which remains very common cause of acute surgical abdomen. The diagnosis may be straightforward or tricky due to variable clinical presentations. Emergency appendectomy is usually done on decision taken by surgeon.
Methods: It includes all patients admitted for pain in the right iliac fossa with provisional diagnosis of Acute appendicitis and treated at SAMC PGI, including all patients above the age of 16 years admitted with pain in the right iliac fossa with provisional diagnosis of Acute Appendicitis and excluding those with severe cardiac risk for surgery, associated malignancy or with associated ascites.
Results:A total of 95 patients were included in our study out of which 9 patients were diagnosed with different pathology than appendicitis. Out of 86 confirmed with appendicitis 69.76% were male and 30.24% were female. Maximum incidence in adult age group seen in 20-40 years (67%).Incidence after 50 years of age is very less (4.65%)
In our study out of 51 modified Alvarado score positive cases, 49 (96%) were histologically positive and 2 (4%) were negative. Whereas among remaining 35 modified Alvarado score negative cases only 20 (57.14%) were histologically positive with a p value <0.0001. Among the 68 ultrasonography positive cases for appendicitis, 65 (95.5%) were also found to have positive features of appendicitis on histopathologically examination and out of them 3 (4.4%) were histologically negative.
Conclusions:Acute appendicitis is one of the most common acute abdominal conditions requiring emergency surgery and its diagnosis remains challenging. Thus we finally conclude that incorporation of modified Alvarado scoring system for establishment of diagnosis in cases of suspected acute appendicitis surely provides higher accuracy of diagnosing acute appendicitis and helps in decreasing negative appendectomies.