The Study of Accuracy of Alvarado Score, CRP, Bilirubin Level and Mean Platelet Volume in the Diagnosis of Acute Appendicitis in a Tertiary Care Centre

Abstract

Acute appendicitis is one of the common surgical emergencies and when it progresses to appendicular perforation, morbidity and mortality becomes much higher. Nearly 6% of the population is expected to have appendicitis in their lifetime. Though absolute diagnosis is only possible at operation and histopathological examination of the specimen, many scoring systems are available for the diagnosis of acute appendicitis. Among them Alvarado scoring system is an important one which is based on history, clinical examinations and few laboratory tests. Recent studies have shown the association of hyperbilirubinemia with acute appendicitis and appendicular perforation. Many reports have investigated the value of raised C reactive protein (CRP) and reduced mean platelet volume (MPV) in improving the diagnosis of acute appendicitis. The objective of our study was to evaluate the accuracy of Alvarado scoring system and CRP as a preoperative diagnostic tool in acute appendicitis and to evaluate whether hyperbilirubinemia and reduced MPV has a predictive potential for its diagnosis. A total of one hundred one patients coming to our emergency in a study period of one year were included. It was observed that the sensitivity, specificity, positive predictive value of Alvarado score was 82.7%, 70% and 96%, CRP level- 96.5%, 63.6%, 95.4%, total bilirubin level- 96.4%, 19%, 60.91%, MPV level- 95.7%, 16%, 51.72% respectively and the P value was clinically significant for Alvarado score, CRP level, total bilirubin level but not for MPV. We conclude that Alvarado score, raised total bilirubin level and CRP level are very effective in the diagnosis of acute appendicitis in both men and women but some other diagnostic modality may be necessary to ascertain the diagnosis in females to rule out pelvic pathology and to reduce negative appendicectomy rate.