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Comparative study of diagnostic accuracy of modified alvarado score, ultrasonography and operative findings in relation to histopathological reports in acute appendicitis

Author: 
Abd-El-Aal A. Saleem
Subject Area: 
Health Sciences
Abstract: 

Objective: To assess the diagnostic accuracy of modified Alvarado scoring system, abdominal ultrasonography and operative findings in comparative to histopathological study in patients suffering from acute appendicitis. Methods and Patients: This was a prospective study of 100 patients who underwent appendecictomy for suspected acute appendicitis. The patients were of both males and females their age ranged from 12- 47 years. The data were collected within one year including sociodemograghic data, Modified Alvarado Scoring System (MASS), abdominal ultrasonography, operative findings which were correlated with histopathological reports. Also operative procedure done, postoperative complications, hospital stay and outcome. Results: Out of 100 patients, the maximum percentage of patients were in age group 21-40 years (56%), males more than females (68% vs 32%, ratio 2.13:1). 76% had MASS ≥7, 68% had +ve ultrasonography findings for acute appendicitis. Histopathological positive reports were 80%. Ultrasonography compared to histopathology reports shows, sensitivity = 60%, specificity = 0%, PPV = 70.59%, NPV = 0% and accuracy =30%. MASS compared to histopathology reports at cutoff point = 6 shows, sensitivity = 90%, specificity = 40%, PPV = 85.71%, NPV = 50% and accuracy = 65%. Also, MASS compared to histopathology reports at cutoff point = 7 shows, sensitivity = 85%, specificity = 60%, PPV = 89.47%, NPV = 50% and accuracy = 72.50%. ROC curve for diagnosis of acute appendicitis according to MASS:- AUC = 0.87, standard error =0.034and CI = 0.80-0.93. Both MASS and histopathological positive reports were more prevalent among all age groups at cutoff point ≥7 than at cutoff point <7. MASS at cutoff point = 7 shows more Sensitivity, specificity, positive predictive value, negative predictive value and accuracy in males (86.67, 100, 100, 50, 93.33 respectively) than females (80.00, 33.33, 66.67, 50, 56.67 respectively). Conclusion: From present study, it is concluded that modified Alvarado scoring system is better diagnostic tool than ultrasonography alone in diagnosis of acute appendicitis because of the MASS provides high degree of sensitivity, specificity, PPV, NPV and accuracy in diagnosis of acute appendicitis in relation to histopathological study. MASS has to be more helpful in male patients by showing lower negative appendicectomy rate and high sensitivity, specificity, PPV and accuracy for male patients as compared to females. But still neither MASS nor ultrasonography is absolute tool in reducing negative appendicectomy in patients of suspected appendicitis.

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