EVALUATION OF MODIFIED ALVARADO SCORE IN DIAGNOSIS OF ACUTE APPENDICITIS- A PROSPECTIVE STUDY COMPARING THE SCORE WITH HISTOPATHOLOGY
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Objectives-Acute appendicitis is one of the common causes of acute abdomen, especially in the younger population. Failure of early diagnosis and appropriate treatment can lead to progression of the disease and fatal complications. Definitive treatment in majority of cases is appendicectomy, but the decision to do appendicectomy based on clinical suspicion alone can lead to removal of normal appendix in 15 to 30% of cases. The aim of this study is to assess the efficacy of Modified
... cacy of Modified Alvarado score in decision making and thereby reducing the incidence of negative appendicectomy. MATERIALS AND METHODS A total of 100 patients were analysed for this prospective study conducted from January 2014 to June 2015, at a tertiary centre in south India. All patients clinically diagnosed as acute appendicitis were evaluated using modified Alvarado scoring system and the score obtained in each case recorded in the proforma. Patients with high suspicion of acute appendicitis by the surgeon irrespective of the score were taken up for surgery, following surgery all appendix specimens were sent for histopathologic examination. The scoring system is then correlated with the histopathology reports. RESULTS The negative appendectomy rate was 3.79% (males 5%, females 15.38%). Sensitivity of the scoring system was 90.47% (males 98.48%, females 78.57%). Specificity was 81.25% (males 75%, females 83.3%). Positive predictive value was 96.20% (male patients 98.48%, female patients 84.6%). Negative predictive value was 61.9% (male patients was 75% and female patients was 76.9%). CONCLUSION Modified Alvarado score increases the diagnostic certainty of clinical examination in acute appendicitis, reducing the progression of the disease to perforation and other complications. Misdiagnosis leading to negative appendectomy can also be reduced, thus avoiding the morbidity of the procedure.