Diagnosis of Acute Appendicitis in Sub-Saharan Africa

Abstract

Objective: The aim of our study was to propose a solution for rationalizing requests for ultrasound examination and CT scan in suspected acute appendicitis, based on use of the Alvarado score. Patients and Methods: We included in our study all patients consulting for pain of the right iliac fossa, whatever their age and sex, who had been diagnosed with acute appendicitis and who had undergone appendectomy. We used the Alvarado scoring system, based on clinical items and laboratory measurements, to diagnose appendicitis. Results: One hundred eleven patients, of whom 77 were men (69.4%) and 34 were women (30.6%), with a sex ratio of 2:2.6, were included. Mean age was 31.29 ± 1.31 years, with a range of 1 to 81 years. The diagnosis of definite appendicitis was established in 54 patients (48.6%). Abdominal ultrasound examination had been performed in 80 patients (72.1%). It established a diagnosis of appendicitis in 69 patients (86.2%), while in 11 patients (13.8%) the appendix was described as normal or was not visualized. Conclusion: Our study demonstrated good agreement between preoperative diagnosis and the result of the Alvarado score applied a posteriori. Ultrasound was not always contributory to the diagnosis of acute appendicitis. It could be reserved for patients whose clinical and laboratory score indicated that appendicitis was unlikely.

Diagnosis of Acute Appendicitis: A Cross-sectional Study on Alvarado’s Score from a Low Income Country

“…[34][35][36][37] On the other hand, the percentage of patients who had a score of four and less was smaller in our study compared to other reports. [36][37][38][39] The overall sensitivity of Alvarado score in this study was found to be similar with a result from one systematic review and another report from Morocco but significantly higher when compared to reports from Jordan, Tunisia, and Pakistan. 37,40,[44][45][46] On the other hand, the overall specificity of this score in our study (55.6%) was lower when compared to other reports in which it was in the range of 75-92.3%.…”

“…The predominance of men seen in this study is also reflected in other reports. [36][37][38][39][40][41][42] Our patients were found to be relatively young when compared to other study participants in studies done elsewhere while other scholars reported a comparable mean age with our patients. [38][39][40]42,43 The mean Alvarado score in this study was found to be similar with a study from Qatar while it was higher compared to reports from India and Pakistan.…”

“…[36][37][38][39][40][41][42] Our patients were found to be relatively young when compared to other study participants in studies done elsewhere while other scholars reported a comparable mean age with our patients. [38][39][40]42,43 The mean Alvarado score in this study was found to be similar with a study from Qatar while it was higher compared to reports from India and Pakistan. 40,42,43 The majority of our study participants (61.7%) had an Alvarado score of seven and above which was much lower than a report from Morocco (91%).…”