MODIFIED ALVARADO SCORE VERSUS ULTRASOUND EXAMINATION IN ACUTE APPENDICITIS
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2017, Vol 4, Issue 69
Abstract
BACKGROUND Appendicitis, one of the most common causes of acute surgical abdomen, presents with a myriad of symptoms and signs resulting in a potential for delay in diagnosis or misdiagnosis. As a result, timely diagnosis is of paramount importance to avoid potential complications. However, appendicectomy based on mere clinical suspicion results in an increased incidence of negative appendicectomies. In this context, modified Alvarado score and ultrasound examination can aid in confirming suspected acute appendicitis. We conducted this study to find out the diagnostic accuracy of ultrasound examination and modified Alvarado scoring system. MATERIALS AND METHODS This prospective study of 150 patients was conducted in department of General Surgery, Govt. Medical College, Kottayam. Study involves application of modified Alvarado scoring system and performing ultrasound scan inside Kottayam Medical College Hospital in all cases. Modified Alvarado Score (MAS) is obtained by proper history taking, clinical examination and laboratory values. Following emergency appendicectomy of all cases the specimen was sent for histopathological diagnosis. RESULTS This study included 150 consecutive patients diagnosed with acute appendicitis undergoing emergency appendicectomy. There were 96 (64%) male patients and 54 (36%) female patients. As per the modified Alvarado scoring, 125 (83.3%) of the patients were diagnosed to have acute appendicitis. However, only 104 (69.3%) of the patients were diagnosed as acute appendicitis by sonological findings. This study showed rebound tenderness as the most common MAS factor, it was present in 147 cases (98%). It was followed by ‘Migratory pain’ which was present in 129 cases (86%). The area under the curve for the ROC for total modified Alvarado scoring was 0.77 (CI 0.62-0.92) figure-3. The sensitivity of USG was 73.4% whereas that of Modified Alvarado score was 86.3%. Specificity of USG was 81.8% and that of Modified Alvarado score was 54.5%. Positive predictive value was 98.1% and 96% respectively. The negative predictive value was 19.6% and 24% for USG and Alvarado scores. CONCLUSION From the present study, it can be concluded that modified Alvarado score is a better diagnostic tool than ultrasonography alone. However, neither modified Alvarado score nor ultrasonography is an absolute tool in reducing negative laparotomy. Both when used together have reduced negative appendicectomy rate by a large number.
Authors and Affiliations
Binni John, Geo Paul K. Jose, Vipin Chandran Chandrasekharan Nair
Keywords
Related Articles
- EP ID EP272238
- DOI 10.18410/jebmh/2017/819
- Views 67
- Downloads 0
EVALUATION OF ANTIMICROBIAL UTILIZATION PATTERN IN A MEDICAL INTENSIVE CARE UNIT OF A TERTIARY CARE TEACHING HOSPITAL
BACKGROUND Antimicrobials are one of most commonly used drugs in the admitted patients especially in critical care unit. Seriously ill patients require critical care and multiple antibiotics for various infections as the...
IS THERE AN ASSOCIATION BETWEEN RENAL RESISTANCE INDEX AND EARLY POST RENAL TRANSPLANT FUNCTION?
BACKGROUND The Intrarenal Resistance Index (RI) measured by colour Doppler ultrasound early after renal transplant period is to assess renal allograft function, although significance of resistive index remains unclear. H...
UTILITY OF FNAC IN UNCOMMON INFLAMMATORY AND REACTIVE LESIONS OF BREAST: AN UNSUSPECTED CLINICAL SCENARIO
BACKGROUND Fine Needle Aspiration Cytology (FNAC) has become an invaluable tool in the preoperative evaluation of the breast lumps and is a part of initial screening by triple assessment approach. Its main purpose is to...
MAGICO-RELIGIOUS BELIEF IN PSYCHOSIS
BACKGROUND Magico-religious beliefs are widely prevalent in India and eastern countries compared to western countries. This causes the patients and their families spending extra ordinary time, money and effort in seeking...
HAEMODYNAMIC EFFECTS OF ETOMIDATE AND PROPOFOL ON INDUCTION OF GENERAL ANAESTHESIA AND ENDOTRACHEAL INTUBATION- A CLINICAL COMPARISON
BACKGROUND An ideal induction agent for general anaesthesia should have haemodynamic stability, minimal respiratory side effects and rapid clearance. Sudden hypotension has a deleterious effects on maintaining the circul...