Medical Audit of Appendisectomies in Rural Based Tertiary Care Centre.

Abstract

Acute appendicitis is one of the common surgical emergencies. There are various scoring systems in use to diagnose appendicitis. The aim of this study was to estimate the diagnostic accuracy of appendisectomies by using the modified Alvarado scoring system and histopathology for acute appendicitis. A prospective study was conducted on 100 patients hospitalized with abdominal pain suggestive of acute appendicitis and were subsequently operated, from June 2010 to July 2011 NKP SIMS & LMH Nagpur. Both male and female patients from 7 years to 55 years of age were enrolled in the study. Preoperatively, modified Alvarado score was assigned to all, and results were compared with Histopatholgical diagnosis. Out of 100 operated patients 81 were diagnosed as acute appendicitis on the basis of Histopatholgical report. Patients with modified Alvarado score of 8-10, 5-7 and 1-4 have the accuracy of 90%, 79%, and 0.4% respectively. In the higher score group the accuracy is more and acceptable. Lower score group should be kept under observation. Score sensitivity is more in male than female patients. This scoring system is a reliable and practicable diagnostic modality to increase the accuracy in diagnosis of acute appendicitis and thus to minimize unnecessary appendisectomies. 1 was first reported by Reginald Heber Fits in 1886 .Still acute appendicitis has remained the most common acute surgical condition of the abdomen in all ages and evidently a common disease in surgical practice 2 . Even after a long period of about more than 120 years from its first depiction this common surgical disease continues to remain a diagnostic problem and can confuse most of the clinicians. Delay in diagnosis definitely increases the morbidity, mortality, and expenditure of management and in equivocal cases, destructive surgical approach too. Although being so common its diagnosis still remains challenge