Application of Modified Alvarado scoring system in the diagnosis of acute appendicitis: a study in a tertiary care hospital
DOI:
https://doi.org/10.18203/2320-6012.ijrms20183876Keywords:
Acute appendicitis, Modified Alvarado scoringAbstract
Background: Acute Appendicitis is one of the common surgical diseases which require early intervention; however, it may lead to higher negative appendicectomy rates, in uncertain Diagnosis. Negative appendicectomy rate is 20-40%. There are various scoring systems to assist in diagnosis. The aim of this study is to assess the effectiveness of Modified Alvarado Scoring System (MASS) in patients with acute appendicitis in AGMC and GBP Hospital.
Methods: This was a cross sectional study to evaluate the effectiveness of MASS in patients presenting with acute appendicitis. The Principal Investigator scored all the patients according to the variables of MASS and divided them into three groups. Group I included patients with MASS of four and below, Group II were patients with MASS of 5-6 and Group III included patients with MASS of seven and above. The diagnosis of acute appendicitis was confirmed by histopathological examination. Data was collected using a coded, pre-tested questionnaire and analyzed using SPSS statistical software version 11.5.
Results: In this study, 36 cases out of 42 cases had acute appendicitis. The sensitivity of Modified Alvarado Score of >7 was 85.7% (proportion of true positive). The sensitivity was highest among males i.e., 92% while in females, it was 76.4%. Negative appendicectomy rates were highest among females (23.6%), whereas in case of males it was 8%.
Conclusions: The present study has shown that MASS provides high degree of sensitivity, specificity, PPV, NPV and accuracy in the diagnosis of acute appendicitis and has found to be more helpful in and high positive predictive value for male patients as compared to females.
References
Douglas SS, Soybel DO. Appendix and Appendectomy, Chapter 21. In Maingot’s Abdominal Operations, Michael J Zinner, Stanley W Ashey, McGraw Hill; 11th Edition; 2007:589-612.
O'Connel PR. The Vermiform Appendix. Chapter 67. In Bailey and Love's-Short practices of surgery, Norman S Williams, Christopher J.K. Bulstrode, P Ronan O’ Connel; London. Arnold: 25th Edition; 2008;1204-1218.
MJaffe B, Berger DH. The appendix. Chapter 29. In Schwartz’s -Principles of Surgery, F Charles Brunicardi; New York. McGraw- Hill: 8th Edition; 2005;1119-1137.
Fitz RH. Perforating inflammation of the vermiform appendix: With Special reference to its early diagnosis and treatment. Trans Assoc Am Physicians. 1886;1:107.
Körner H, Söndenaa K, Söreide JA, Andersen E, Nysted A, Lende TH, et al. Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis. World J Surg. 1997 Mar 1;21(3):313-7.
Dado G, Ananias G, Baccarani U, Marcotti E, Donini A, Risaliti A. Application of a clinical score for the diagnosis of acute appendicitis in childhood. J Pediatr Surg. 2000;35:1320-2.
Eal P. Clinical Practice: Suspected Appendicitis. NEJM. 2003;248:236-42.
Gilmore OJA, Jones D, Ynag Q. Appendicitis and mimicking conditions. Lancet. 1975;II:421-4.
Kalan M, Talbot D, Cunliffe WJ, Rich AJ. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg. 1994;76:418-9.
Ohmann C, Yang Q, Franke C. Diagnostic scores for acute appendicitis. Euro J Surg. 1995;161:273-81.
Fenyo G, Lindberg G, Blind P, Enochsson L, Oberg A. Diagnostic decision support in suspected acute appendicitis: validation of a simplified scoring system. Eur J Surg Med. 1997;163:831-8.
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg. 1986;15:557-65.
Stephens PL, Mazzucco JJ. Comparison of ultrasound and the Alvarado score for the diagnosis of acute appendicitis. Conn Med. 1999;63:137-40.
Saidi HS, Chavda SK. Use of a modified Alvarado score in the diagnosis of acute appendicitis. East Afr Med J. August 2003;80(8):411-4.
John Maaand Kimberly S. Kirkwood. The appendix, Chapter 49, in Sabiston Textbook of Surgery, Saunders: 2008;2(18);1333-47.
Kurane SB, Sangolli MS, Gogate AS. A one year prospective study to compare and evaluate diagnostic accuracy of modified Alvarado score and ultrasonography in acute appendicitis, in adults. Indian J Surg. 2008 Jun 1;70(3):125.
Al-Hashemy AM, Seleem MI. Appraisal of the modified Alvarado Score for acute appendicitis in adults. Saudi Med J. 2004 Sep;25(9):1229-31.
James MCrawford. Appendix. Chapter 17 In Robbins and Cotran - Pathologic basis of disease. Kumar, Abass, Fansto; Philadelphia, Pensylvania. Elsevier: 2004;(7):870-71.
Rypins EB, Evans DG, Hinrichs W, Kipper SL. Tc-99m-HMPAO white blood cell scan for diagnosis of acute appendicitis in patients with equivocal clinical presentation. Annals of surgery. 1997 Jul;226(1):58.
Bhattacharjee PK, Chowdhury T, Roy D. Prospective evaluation of Modified Alvarado score for diagnosis of acute appendicitis. J Indian Med Assoc. May 2002;100(5): 310-1,314.
Bengezi, OA, Fallouji ALM. Modified Alvarado Score in Diagnosis of Acute Appendicitis. The British Journal of Surgery. 1997 Suppl. May;84:30.
Fente BG. Echem RC. Prospective evaluation of the Bengezi and Al-Fallouji modified Alvarado score for presumptive accurate diagnosis of acute appendicitis in University of Port Harcourt Teaching Hospital, Port Harcourt. Niger J Medi. 2009;18(4):398-401.
Burkitt DP: The aetiology of appendicitis. Br J Surg. 1971;58:695.
Butler C. Surgical pathology of acute appendicitis. Hum Patho. 1981;12:870.
Miranda R, Johnston AD, O'Leary JP. Incidental appendectomy: Frequency of pathologic abnormalities. Am Surg. 1980;46:355.
Rautio M, Saxen H, Siitonen A, Nikku R, Jousimies-Somer H. Bacteriology of histo pathologically defined appendicitis in children. Ped Inf Disea J. 2000 Nov 1;19(11):1078-83.
