DOI: http://dx.doi.org/10.18203/2349-2902.isj20211295

Comparative study between clinical diagnosis using modified Alvarado score and ultrasound imaging in decreasing negative appendectomy rate

Sayali S. Samudre, Anil S. Munde

Abstract


Background: Acute appendicitis is the acute inflammation of appendix which is the most common cause of acute surgical emergencies. Appendicitis can mimic other pathologies. Removing normal appendix is an economical burden both on patients and health resources. Misdiagnosis and delay in surgery can lead to complications like perforation and finally peritonitis.

Methods: This was prospective comparative study carried out in 200 patients over the period of 2 years. Patients with clinical features of acute appendicitis and fitting in inclusion and exclusion criteria were selected. Detailed history was noted and clinical examination was done. Necessary investigations were done, modified Alvarado score was calculated and all were subjected to ultrasonography of abdomen and pelvis. Intra operative findings were noted about nature of appendix and histopathology findings were noted.

Results: The sensitivity of ultrasound is 78.19% and specificity is 50%. The sensitivity of modified Alvarado scoring system is 78.7% and specificity is 25%. Negative appendicectomy rate in the study was 6%.

Conclusions: Modified Alvarado score has slightly higher sensitivity and ultrasound imaging has higher specificity of in the diagnosis of acute appendicitis and in decreasing negative appendicectomy rates. Ultrasound imaging provides good supportive diagnosis in cases of low or equivocal modified Alvarado scores.


Keywords


Appendicitis, Modified Alvarado score, Ultrasound imaging, Negative appendectomy

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References


Williams NS. Bailey and Love’s short practice of surgery, 25th ed, London: Edward Arnold Ltd. 2008;1204-18.

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

Hoffmann J, Rasmussen O. Aids in the diagnosis of acute appendicitis. Br J surg. 1989;76:774-9.

Schwartz's Principles of Surgery, Ed 9th. The McGraw-Hill Companies. 2010.

Ohmann C, Yang Q, Franke C. The abdominal pain study group. Diagnostic scores for acute appendicitis. Eur J Surg. 1995;161:273-81.

The Appendix. In Maa J, Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier. 2008;1333-47.

Douglas CD. Randomized controlled trial of ultrasonography in the diagnosis of acute appendicitis, incorporating the Alvarado score. BMJ. 2000;321:919-22.

Bhattacharjee PK, Chowdary T, Roy D. Prospective Evaluation of modified Alvarado Score for diagnosis of acute appendicitis. J Indian Med Asso. 2002;100:S.

Puylaert JBCM. Acute appendicitis-US evaluation using Graded compression. Radiology. 1986;158;355-60.

Gallego G, Neto F, Fernandej C. evaluation of ultrasonography and clinical diagnostic scoring in suspected appendicitis. Br J Surg. 1998;85:3740.

John GM, Pattanayak SP, Panda C, Mohan Rao KRR. Evaluation of Ultrasonography as a Useful Diagnostic Aid in Appendicitis. IJS.2002;64,5;436-9.

Jeffery RB Jr, Laing FC, Townsend RR. Acute appendicitis: sonographic criteria based on 250 cases. Radiology. 1988;167:327-9.

Zeidan BS, Wasser T, Nicholas GG. Ultrasonography in the diagnosis of acute Appendicitis. J R Coll Surg Edinb. 1997;42:24-6.

Fa EM, Cronan JJ. Compression ultrasonography as an aid in the differential diagnosis of appendicitis. Surg Gynecol Obstet. 1989;169:290-8.

Abu-Yousuf MM, Phillips ME, Franken EA Jr, Al-Jurf AS, Smith WL; Sonography of acute appendicitis: a critical review: Crit Rev Diagn Imaging. 1989; 29 (4):381-408.

Adams DH, Fine C, Brooks PC. High-resolution real-time ultrasonography: A new tool in the diagnosis of acute appendicitis. Am J Surg 1988;155:93-97.

Mohanty S, Si K. Evaluation of modified Alvarado score in decreasing negative appendicectomy rate-our experience. IJS. 200;62:5;342-3.

Gerick B, Kubikova E, Jakubovsky J. Clinical histopathologic picture of acute appendicitis in children. Rozhchir. 2000;79(5);211-4.