CLINICAL STUDY ON ACUTE APPENDICITIS INCORPORATING MODIFIED ALVARADO SCORE AND ABDOMINAL ULTRASOUND

Abstract

Acute appendicitis is one of the most common acute abdominal surgical emergencies the diagnosis of which is often challenging. If there is a delay in the diagnosis and prompt action is not taken, it may lead to perforation and other complication. Many scoring systems have been devised for the diagnosis of appendicitis, among which Modified Alvarado score is being used widely. Ultrasound also has gained importance in recent years. Our study aims in combining the use of Modified Alvarado score and USG in the diagnosis to bring down the rate of negative appendicectomies. Aimof The Study 1. To evaluate the sensitivity of the use of modified Alvarado scoring system and ultrasound in the diagnosis of acute appendicitis 2. To reduce the rate of negative appendicectomy. Materials & Methods: This study was done in 100 patients admitted in Navodaya Medical College Hospital from November 2019 to May 2021. All patients chosen on purposive sampling basis who present with right lower quadrant pain. Preoperatively, modified Alvarado score and abdominal ultrasound are assigned to those included in the study. Intraoperative findings and histo-pathological reports are followed up and the results are compared with modified Alvarado score and abdominal ultrasound. Results 1. In our study, the sensitivity of Modified Alvarado score in diagnosing Acute Appendicitis in the score range of 1-4 is 60%, so 6 out of 10 patients were confirmed with Acute Appendicitis. 2. In the score range of 5-7, out of 26 patients, 24 patients were confirmed with Acute Appendicitis using HPE having 92.3% sensitivity. 3. In the score >7, out of 64 patients , 63 patients had Acute Appendicitis confirmed with HPE and the sensitivity of HPE was the highest among this score range and its found to be 98.43%.The remaining 7 patients had normal appendix. 4. In our study, the sensitivity of USG Abdomen in diagnosing Acute Appendicitis was 95.83% in the score range of 5-7, 71.42% in score range of >7 and 66.6% in score range of 1-4.Out of 100 patients, USG abdomen showed positive result for Acute Appendicitis in only 72 patients when compared to HPE which showed 93 patients with Acute Appendicitis. Interpretation & Conclusion: Modified Alvarado scoring system is the better indicator for confirmation of diagnosis of Acute Appendicitis in the clinical setting rather than relying on USG abdomen imaging modality of investigation for diagnosing and treating the patient with Acute Appendicitis. When we incorporate both Modified Alvarado Scoring system and USG abdomen then we can diagnose Acute Appendicitis with accuracy close to HPE diagnosis of Acute Appendictis.