A relationship between Clinical diagnosis, Modified Alvarado Score and Histopathological Findings in Acute Appendicitis

IK Jha

Abstract


Introduction: Acute appendicitis is a common surgical condition; yet its diagnosis can be elusive at times and missed diagnosis can lead to attendant complications of perforation and its sequelae. Decision-making in patients with acute appendicitis poses a diagnostic challenge worldwide. The Modified Alvarado Scoring System (MASS) has been reported to be a cheap and quick diagnostic tool in patients with acute appendicitis. The aim of this study was to investigate the accuracy of clinical diagnosis and Modified Alvarado score in acute appendicitis .

Methods: A prospective observational study was carried out from July 2012 to December 2013 in the surgery department of Bir Hospital and a total of 100 cases of acute appendicitis were enrolled. MA score, were computed for each patient; the suggested cutoff values by the authors of this score were used to find out the accuracy These patients underwent surgery and specimen was sent for histopathological examination.The clinical finding and histopathological report was correlated finally. Data was processed by SPSS software and Microsoft excel.

Result: Total of 100 of AA, 69% were male and 31% were female. The age group presenting maximum number of cases (49%) was in age group of 15 to 24 years. Acute appendicitis was confirmed in 90% of these patients. MAS between 7 to 9 had confirmed AA in 96% where as 5 to 6 had AA in 82.4% MAS between 0 to 4 had acute appendicitis in 20%. The Sensitivity and specificity for MAS were 86.2% and 72.72% respectively with PPV 96.15% and NPV 40%. The PPV for clinical diagnosis was 88.77%.

Conclusion: In the diagnosis of acute appendicitis, the modified Alvarado score is a fast, simple, reliable, noninvasive, and safe diagnostic modality without extra cost and complications. The application of this scoring system improves diagnostic accuracy and consequently reduces negative appendicectomy and thus reduces complication rates.

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