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Evaluation of modified alvarado scoring system in adults in diagnosis of acute appendicitis

Author: 
Dr. Azra Mubeen Karnul
Subject Area: 
Health Sciences
Abstract: 

Background and Objectives: Appendicitis is common surgical disease which continues to remain a diagnostic problem and can baffle best of the clinician. Delay in diagnosis definitely increases the morbidity, mortality and cost of treatment. In equivocal cases, however, aggressive surgical approach in spite of advancements in medical diagnostics, its diagnosis is mainly clinical one. Thus the objectives of this study are to evaluate the diagnostic efficacy of modified alvardo score in patients of acute appendicitis and to find out gender differences. Methods: The study was prospective and conducted in a group of 100 cases admitted in department of general surgery with suspected appendicitis. The study involved application of modified Alvarado scoring system to all 100 cases before surgery and co related with histopathology reports. Results: In our study number of male and female patient is 52% and 48% respectively. Highest incidence was seen in age group of 21-30 (29%). Distribution of the patients according to Modified Alvarado Score in >7 range is 45. Out of those 45 patients, 42 (93.3%) had acute appendicitis and 3(6.66%) patients were having normal appendix on histopathology. Negative appendisectomy rate is 6.6%. Distribution of the patients according to modified Alvarado score of <7 is 55%. Out of those 55%, 22(40%) had acute appendicitis, 33(60%) patients were having normal appendix on histopathology. Negative appendisectomy rate is 60%. With modified Alvarado score >7, 19(45.23%) male patients were histopathological positive and 23(54.76%) females patients were histopathological positive. With modified Alvarado score <7, 14(63.67%) male patients were histopathological positive and 8(36.36%) female patients were histopathological positive. The sensitivity, specificity, accuracy, positive predictive predictive value in males were 97%, 94.7%,75%,92.05% respectively, while in females were 96.8%, 94%, 88%, 99.56% respectively. The overall sensitivity =96.93% specificity=97.14%, accuracy= 95.2%, positive predictive=93.65%, negative appendisectomy rate is 6.67%. Conclusion: Thus, applying Modified Alvarado scoring system preoperatively as a protocol in patients with suspected appendicitis is useful in reducing negative appendisectomy rates.

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