Background: Acute appendicitis is the most common cause of an ‘acute abdomen’ in young adults.  Notwithstanding advances in modern radiographic imaging and diagnostic laboratory investigations, the diagnosis of appendicitis remains essentially clinical, requiring a mixture of observation, clinical acumen and surgical science. Several scoring systems have been developed in attempts to quantify and improve the accuracy of clinical assessment. The initial and most well-known was devised by surgeon Alfredo Alvarado in 1986. Imaging is vital to accurate and prompt diagnosis when the clinical presentation is equivocal. The aim of this study is to compare the utility of Alvarado score and ultrasound in diagnosis of acute appendicitis.

Material & Methods: An retrospective study was conducted over a period from Jan 2017 to Apr 2018 at our centre, a mid-zonal hospital under Armed Forces, India. Total 30 cases who underwent Emergency Appendicectomy were included in study. Patients who had Alvarado score >7 were assumed to have a preoperative diagnosis of Acute appendicitis and proceeded with emergency appendicectomy. Ultrasound examination is done following the clinical examination for all patients included in the study. Those patients having Ultrasonographic diagnosis of Acute Appendicitis were proceeded with Emergency Appendicectomy. The appendix removed was sent for Histopathologic Examination. Histopathologic Examination diagnosis was regarded as final diagnosis. Utility of Alvarado Score and Ultrasonography in making a preoperative diagnosis of Acute appendicitis is then seen and compared.

Results: Acute Appendicitis is more common in age groups 11-40 years and is rare in age <10 years and >40 years. The disease is more common in males. Alvarado Score has high sensitivity (95.8%) for Acute Appendicitis. It also has high positive predictive value (88.5%)for the disease. Ultrasonography on the other hand is moderately sensitive (79.2%) for Acute Appendicitis but has high positive predictive value (86.4%). However, Ultrasonography has very low negative predictive (37.5%).

Conclusion: Incidence of appendicitis is definitely higher in adolescents and young adults. The disease is more common in males than in females. Alvarado score is highly sensitive while Ultrasonography is moderately sensitive in diagnosing appendicitis. Alvarado score has good PPV and NPV for appendicitis. US while having good PPV, has low NPV for diagnosing appendicitis.  Both Alvarado Score and US can be used as a good screening tool for diagnosing appendicitis.

Keywords: Alvarado Score, Appendicectomy, Appendicitis, Emergency, Surgery, Ultrasonography.

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Hem Chander Pandey

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