To evaluate the diagnostic accuracy of alvarado score, C-reactive protein, ultrasonography and computed tomography in acute appendicitis and to correlate them with operative and histological findings
DOI:
https://doi.org/10.18203/2349-2902.isj20164470Keywords:
Acute appendicitis, Mantrels, Negative appendicectomy rateAbstract
Background:Despite extraordinary advances in modern radiology and laboratory investigations an accurate diagnosis of acute appendicitis cannot be made in atypical cases. No single diagnostic aid can dramatically reduce the rate of negative appendicectomy.
Methods: To reduce the rate of negative appendicectomies by the combined use of diagnostic modalities in a prospective study from July 2011 to December 2012 was done. 100 patients with right lower quadrant abdominal pain fulfilling the inclusion and exclusion criterion underwent appendicectomy in Mahatma Gandhi Medical College and Hospital, Jaipur, India.
Results:The results of the diagnostic aids were reported in combination using the ‟or” rule and were correlated with intraoperative and histopathological findings. Chi-square test was applied to calculate the p value for the association between the variables of studied. The mean age was 26±11.25 years (10-59 years) and there were 70 males and 30 females in the study. Histopathological examination confirmed appendicitis in 90 patients with 10 negative appendicectomies. A negative appendicectomy rate of 5.71% in men and 20% in women was observed.
Conclusions:Alvarado score in combination with ultrasonography is a valuable tool for diagnosing acute appendicitis inspite of sophisticated investigations like CT, thus reducing the cost of treatment and preventing negative appendicectomy rate.
Metrics
References
Alvarado A. A practical score for early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557-64.
Kalan M, Talbot D. Evaluation of the modified alvarado score in the diagnosis of acute appendicitis-a prospective study: Ann Coll Surg Engl. 1994;76:418-9.
Stephens PL, Mazzucco JJ. Comparison of ultrasound and alvarado score for the diagnosis of acute appendicitis. Conn Med. 1999;63:137-40.
Hoffmann J, Rasmussen OO. Aids in the diagnosis of acute appendicitis. Br J Surg. 1989;76:774-9.
Mlavi MA, Suleri M. Practicality of modified diagnosis of acute appendicitis. Pak J Surg. 2007;23:4.
Tauro LF, Aithala PS. Utrasonography is still a diagnostic tool in acute appendicitis. J Clinic Diagnostic Res. 2009:3:1731-6.
Jawaid A, Asad A. Clinical scoring system; a valuable tool for decision making in a case of acute appendicitis. J Pak Med Assoc. 1999;49(10):254-9.
Sadaf A, Shah A. Role of TLC, neutrophil percentage, CRP and USG in the diagnosis of acute appendicitis. Internt J Surg. 2010;24(1):1-7.
Rioux M. Sonographic detection of normal and abnormal appendix; ajr 1992;158:778-887
Rosen MP, Sands DZ. Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain. Ajr Am Roentgenol. 2000;174:1391-6.
Poortman P, Lohle PN. Comparison of CT and sonography in the diagnosis of acute appendicitis: a blinded prospective study. Ajr Am J Roentgenol. 2003;181(5):1355-9.
Balthazar EJ, Megibow AJ. Appendicitis prospective evaluation with high resolution CT. 1991;180:4.
Weyant MJ, Eachempati. Interpretation of CT does not correlate with lab and pathological findings in surgically confirmed acute appendicitis. Surg. 2000;128:145-52.
Nautiyal H, Shmed A. Combined use of modified alvarado score and USG in decreasing negative appendicectomy rate. Indian J Surg. 2010;72:42-8.