Evaluation of Ultrasound and Alvarado Score Combination for the Diagnosis of Acute Appendicitis in Babylon Childrens

Abstract

Background: Acute appendicitis is the commonest cause of emergency abdominal surgeries in children and must be distinguished from other cases of acute abdominal pain. Acute appendicitis not easily diagnosed especially in early stages of the disease. Failure of early diagnosis can lead to progression of the disease with its morbidity and occasional mortality. Ultrasound (US) and The Alvarado score as trials to reduce the negative appendectomy rate without increasing morbidity and mortality. Both have been proven to be a helpful imaging modality and scoring system respectively, in the diagnosis of acute appendicitis in children. Objective: Our study aims to evaluate a combination of clinical scoring (Alvarado score) system and ultrasound findings for accurate diagnosis of acute appendicitis in children. Patient & Method: The study was created in the Babylon Maternity and Pediatric Teaching Hospitals from January 2005 to January 2013. 260 children with right iliac fossa abdominal pain clinically suspected of having acute appendicitis were included in this study and clinically assessed to calculate the Alvarado score. Patients were referred to the radiology department for urgent abdominal US. Results: In present study, 260 patients involved and 114 of them were diagnosed pre-operatively and operated on as acute appendicitis. Of the118patients how were operated, 104 patients proved to have acute appendicitis intraoperatively. The percentage of appendicitis was 88.1% (104/118) and 10 (8.4%) patients had normal appendix. Ovarian cysts pathology was diagnosed in3 girls and another male with omental torsion. The prevalence of appendicitis among the patients of the study was 40% (104/260). Sensitivity of the ultrasound for clinical diagnosis of acute appendicitis was 98.0%, specificity, 96.1%, while that for Alvarado scores 93.0 % and 94.9% respectively. Conclusion: A combination of Alvarado score and abdominal US findings is a good approach for the diagnosis of appendicitis in children to reduce the negative appendectomy rate without increasing morbidity and mortality. In the case of normal appendix or non-visualization of the appendix via abdominal US with a low Alvarado score, appendicitis can be safely excluded. If an inflamed appendix assured on US or a high Alvarado score, patient should be subjected for appendectomy without delay. Patients with low Alvarado scores and positive US findings or moderate and high Alvarado scores with negative US findings should be observed for 24 h and appendectomy is only done when manifestations persist.