Comparative Study of Diagnostic Accuracy of Modified Alvarado Score and Ultrasonography in Acute Appendicitis

Abstract

Acute appendicitis is one of the commonest surgical emergency. A case of appendicitis can progress to perforation and other life threatening complications, which is associated with much higher morbidity and mortality and the surgeons are left with no option than to operate, when diagnosed clinically rather than to wait until it is confirm. Despite the introduction of various scoring system, extraordinary advances in modern radiographic imaging and diagnostic laboratory investigation, the accurate diagnosis of acute appendicitis remains an enigmatic challenge. A scoring system for early diagnosis of acute appendicitis was developed by Alvarado in 1986; based on clinical signs, symptoms and differential leucocyte count, with a left shift of neutrophil maturation yielding a total score of 10; known as Alvarado score. Kalan et al omitted the left shift to neutrophil maturation parameter and produced a Modified Alvarado score. It is a 9 point scoring system that helps in increasing the accuracy of preoperative diagnosis and thus reducing negative appendicectomy rate. Score of 7 or more were recommened for surgery.Various radiological imagings like plain X-ray, barium meal follow through, barium enema, graded compression ultrasonography, colour Doppler ultrasonography, CT scan, MRI has been developed for more accurate diagnosis of acute appendicitis; but no one is confirmatory. It has been claimed that ultrasonography dramatically reduce the number of appendicectomy in patients without appendicitis. It is especially useful in children and young thin adults; and in females it will allow exclusion of gynaecological cause with diagnostic accuracy in excess of 90%.The aim of this study to validate the user friendly pre-operative diagnostic method based on prospectively collected data from patients admitted for suspected appendicitis incorporating the Modified Alvarado Score and graded compression ultrasonography. I. Research Design And MethodsStudy population: Patients of all age group varrying between 7 -65 yrs of age,both male and female,presented in casualty department,OPD&indoor with the clinical features suggestive of acute appendicitis were selected non randomly for the study. Sample size and sample technique:55 patients selected non randomly. Data collection technique and tools: Data was collected as Alvarado score,ultrasonographic finding and histopathologicalreports.alvarado score of >7 were taken as positive and <7 as negative.histopathology showing inflamed appendix were taken as positive an normal appendix as negative.sonographically showing features suggestive of appendicitis in patients with Alvarado score <7 were marked positive. Data analysis:Categorizations of different parameters were performed by simple statistical methods like standard table, Pie diagrams, And Bar charts etc. Statistical analysis was performed using

A Prospective Evaluation of the Combined Use of Modified Alvarado Score and Ultrasonography in Decreasing Negative Appendicectomy Rate

“…13 Satyajeet et al (2014). 18 was quite lower when compared to our study, while study done by Kodliwadmath HB et al (2011). 14 documented sensitivity of 98.8%.…”

“…15 documented lower sensitivity (71.2%) with similar specificity, Satyajeet et al (2014). 18 observed lower specificity (50%), while Nishikant Gujar et al (2015). 19 found both higher sensitivity and specificity with value of 98.44% and 94.44% respectively.…”

“…17 Satyajeet et al (2014). 18 and Nishikant Gujar et al (2015). 19 In this study, we observed that abdominal tenderness (100%) followed by migratory right iliac fossa pain (89.69%) was the most constant component of Modified Alvarado Score, which were present in patients of acute appendicitis.…”

Evaluation of modified Alvarado scoring system in acute appendicitis at Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India

“…It allows exclusion of gyanecological causes that simulating appendicitis in females of reproductive age. 3 Various scoring systems have been developed for assisting the recognition of acute appendicitis but most of them were complex and not feasible in emergency cases. Now-a-days modified Alvarado scoring system (MASS) has become popular for diagnosis of acute appendicitis as it is easy, simple and cheap diagnostic tool to identify the disease condition even by junior surgeons.…”

A prospective study of accuracy of modified Alvarado score in patients with acute appendicitis in tertiary care hospital

“…14 Periumbilical pain was noted in 78% patients which is same as in other studies. 15,16 The role of MAS system in the diagnosis of acute appendicitis was assessed .The study shows that use of scoring system in patients suspected of acute appendicitis provided a high degree of sensitivity and specificity as 91.57% and 76.47% respectively and a positive predictive value of 95%and negative predictive value of 65%. Schirzad N et al documented low result with a sensitivity of 71.2% and specificity of 83.3% and positive predictive value of 89.9% and negative predictive value of 11.5%.…”