Title: Preoperative Diagnosis of Acute Appendicitis: Evaluation of Modified Alvarado Scoring System versus Ultrasonography
Authors: Dr Jawad Kadhim S. Al-Dhahiry. MD, Dr Hassan Khalil Melek. MD, Dr Tareq Khalid Abduljabbar. MD, Dr Mustafa Farhan Yaly .MB.CH.B
DOI: http://dx.doi.org/10.18535/jmscr/v4i8.28
Abstract
Background: an early preoperative diagnosis of acute appendicitis is ocasionally very challenging. Clinical examination and Ultrasonography (USG) are very useful tools to confirm early preoperative diagnosis of acute appendicitis.
Objective: Evaluation of MASS and USG in preoperative diagnosis of acute appendicitis.
Design and Setting: This is a prospective Cohort study performed in AL-Karama Teaching Hospital/ Medical College / University of Wasit /Iraq.
Patients and Methods: A total of 110 patients complaining of Right Lower Quadrant (RLQ) acute abdominal pain with high suspicion of acute appendicitis ,were included in this study during the period from September 2015 to June 2016.They were preoperatively assessd by Modified Alvarado Scoring system (MASS) and abdominal USG. They were appendectomised. The removed appendicies were histopathologically examined. MASS, USG and histopathologic results were statistically analysied.
Results: They were 67 males (60.1%) and 43 females (9.1%). Mean±SD of patients' age was 23.3±11.9 years. The post-operative histopathologic examination proved that 98 (89 %) out of 110 patients had acute appendicites while the remaining 12 (11%) patients had normal appendices. Sensitivity, specificity, Positive Predictive (PPV) ,Negative Predictive Value (NPV) and accuracy rate of MASS with cutoff point 6 were : 89%, 33%, 91%, 28% and 83 % respectively, P-value = 0.04 .When MASS with cutoff point 7, they were 66.3%, 12.8%, 94.2%, 19.5% and 66 % respectively, P-value=0.03.Sensitivity, specificity, PPV, NPV and accuracy rate of USG were :62%, 91%, 98%, 22% and 65 % respectively, P-value=0.01.
Conclusion and Clinical Significane: MASS with cutoff point 6 has high sensitivity and accuracy rate .Despite MASS has a slight increase in negative appendectomies but it improves the early diagnosis and treatment preventing complications of delayed diagnosis such as appendiceal perforation. USG gives dependable findings for early diagnosis of acute appendicitis but, it is an operater dependent needing perfect training.
Keywords: Diagnosis of Acute Appendicitis, Modified Alvarado Scoring System (MASS), Ultrasonography,
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