OBJECTIVE To compare preoperative diagnostic accuracy in cases of Acute Appendicitis with Modified Alvarado Scoring as compared to diagnostic ultrasonographic imaging. DESIGN Cross sectional study. SETTING AND DURATION METHODOLOGY After ethical approval of ethics committee, Rama Medical College Hospital and Research Centre, a sample of 150 patients was collected by non-probability purposive sampling technique during 26 months, who were admitted in this hospital and included in this study and

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... er underwent abdominal ultrasonography and appendectomy and subsequently pathological evaluation of the appendix done for disease appendicitis. Results of outcome of histopathology compared with MASS and ultrasonography results. Patients underwent appendectomy were assessed by senior consultants of the Surgical Department for exclusion of patients with complication of appendicitis and other causes of lower abdominal pain. Modified Alvarado Score System (MASS) was recorded preoperatively, but its result was not disclosed to effect the decision of surgery. After appendectomy, the appendix was sent for histopathology which was taken as gold standard or confirmation of disease. The results of histopathology compared with ultrasonographic imaging diagnosis and Modified Alvarado Scoring System to assess the diagnostic accuracy of both modalities. RESULTS 110 males and 40 female patients were assessed. Of these patients, 134 (89.3%) had histopathology positive acute appendicitis. The sensitivity, specificity, PPV, NPV and accuracy rate of ultrasonography was found 77.6%, 75.0%, 96.2%, 28.7% and 77.3%, respectively. By taking a cut-off point of 7 for the MASS score, a sensitivity of 65.67%, specificity of 37.5%, PPV of 89.79%, NPV of 11.5% and accuracy of 62.6% were calculated. CONCLUSION Ultrasonography provides more reliable information for helping to diagnose acute appendicitis. A cut-off point of 7 for the MASS score has less sensitivity and accuracy as compared to clinical diagnosis assisted with ultrasonography for better diagnosis of appendicitis and to decrease the rate of negative appendectomy. KEYWORDS Acute Appendicitis, Appendectomy, Ultrasonography, Modified Alvarado Scoring System (MASS). HOW TO CITE THIS ARTICLE: Srivastava M, Nigam B, Nigam S, et al. Diagnostic accuracy in cases of acute appendicitis modified Alvarado score system vs. ultrasonographic imaging.