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Category: Volume 06 Issue 05 May 2018
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Title: A Study of Efficacy of Alvarado Score vs Ultrasonography in Evaluation of Suspected Appendicitis

Authors: Hem Chander Pandey, Jyoti Sharma

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i5.126

Abstract

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.

References

  1. Williams, N.S., Bulstrode, C.J.K., O'conel, P.R., 2008. Bailey and Love’s Short Practice of Surgery, 25 th ed. 338 Euston Road, London NW1 3BH: Hodder Arnold, 32-48
  2. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986; 15:557–564
  3. Ohmann C, Yang Q, Franke C. Diagnostic scores for acute appendicitis. Abdominal Pain Study Group. Eur J Surg1995; 161:273–281
  4. McKay R, Shepherd J. The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. Am J Emerg Med 2007; 25:489–493
  5. Schneider C, Kharbanda A, Bachur R. Evaluating appendicitis scoring systems using a prospective pediatric cohort. Ann Emerg Med2007; 49:778–784
  6. Gaikwad V, Murchite S, Chandra S, Modi P. To Evaluate the Efficacy of Alvarado Score and Ultrasonography in Acute Appendicitis. IOSR Journal of Dental and Medical SciencesVolume 15, Issue 9 Ver. XI (September). 2016, 14-18
  7. Green, H. W., and Watkins, R. M. (1946). Appendicitis in Cleveland.Surg. Gynec. Obstet., 83, 613
  8. Love, R. J. McNeill. (1947). The Appendix, p. 16. Lewis, London.
  9. Lee JAH. The influence of sex and age on appendicitis in children and young adults. Gut, 1962, 3, 80-84
  10. Hudson, H. W., and Chamberlain, J. W. (1939). Acute appendicitis in childhood, a statistical study of 848 cases from the Children's Hospital, Boston. J. Pediat., 15, 408
  11. Boyce, F. F. (1949a). Acute Appendicitis and its Complications,p.24. Oxford University Press, New York.(1949b). Ibid., p. 335 et seq.
  12. Bunton, G. L. (1953). Acute appendicitis in infancy and early childhood. Brit. med. J., 2, 71.
  13. Searle AR, Ismail KA, Macgregor D, Hutson JM. Changes in the length and diameter of the normal appendix throughout childhood. J Pediatr Surg. 2013 Jul; 48(7):1535-9
  14. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990 Nov; 132(5): 910-25
  15. Stein GY, Rath-Wolfson L, Zeidman A, Atar E, Marcus O, Joubran S, Ram E. Sex difference in the epidemiology, seasonal variation and trends in the management of patients with acute appendicitis. Langenbecks Arch Surg. 2012 Oct; 397(7): 1087-92
  16. Hwang, J. M. S., and Krumbhaar, E. B. (1940). The amount of lymphoid tissue of the human appendix and its weight at different age periods. Amer. J. med. Sci., 199, 75
  17. Gwynn LK. The diagnosis of acute appendicitis: clinical assessment versus computed tomography evaluation. J Emerg Med 2001;21:119e23
  18. Trout AT, Sanchez R, Ladino-Torres MF, et al. A critical evaluationof US for the diagnosis of pediatric acute appendicitisin a real-life setting: how can we improve the diagnostic valueof sonography? Pediatr Radiol2012;42:813e23
  19. Wiersma F, Sramek A, Holscher HC. US features of the normal appendix and surrounding area in children. Radiology 2005; 235:1018e22.
  20. Rioux M. Sonographic detection of the normal and abnormal appendix. Am J Roentgenol1992;158:773e8.
  21. Sivit CJ, Applegate KE, Stallion A, et al. Imaging evaluation of suspected appendicitis in a pediatric population: effectiveness of sonography versus CT. Am J Roentgenol 2000;175:977e80.
  22. Pacharn P, Ying J, Linam LE, et al. Sonography in the evaluation of acute appendicitis. Are negative findings good enough? J Ultras Med 2010;29:1749e55.
  23. Limchareon S, Wongsuttilert A, Boonyarit A. Efficacy of Ultrasonography in the Evaluation of Suspected Appendicitis in a Pediatric Population. Journal of Medical Ultrasound (2014) 22, 213e217
  24. Tiu CM, Chou YH, Chen JD, et al. Ultrasound diagnosis of acute appendicitis: impact on cost and outcome in pediatric patients. J Med Ultrasound 2004;12:69e74.

Corresponding Author

Hem Chander Pandey

S-63 A, Pandav Nagar, Near Mother Dairy, Delhi-110092, India

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