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

Abstract

Objective: Comparative study of Diagnostic accuracy of Modified Alvarado Score and Ultrasonography in Acute Appendicitis.Research design and methods: A total of 55 patients of age group between 7-65yrs,both male and females,with clinical features suggestive of acute appendicitis were selected non-randomly for the study.Data was collected as Alvarado score,ultrasonograpic findings and histopathological reports.Statistical analysis was performed and results of both Alvarado score and Ultrasonography were compared.Results: Of 55 patients taken,maximum percentage of patients were in age group 10-20yrs with males dominated the series.The sensitivity and specificity of Modified alvarado score was 82.05% and 81.25% with PPV 91.42% and NPV 65% and diagnostic accuracy of 81.82% respectively.Ultrasonography study revealed 84.61% sensitivity and specificity of 56%,PPV and NPV were 80.48% and 57.14% and diagnostic accuracy was 70.91% respectively.Conclusions: From present study,it is concluded that Modified Alvarado score is better diagnostic tool than ultrasonography alone in diagnosis of acute appendicitis. 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 Methods Study 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