Whether Alvarado scoring system is A Reliable Diagnostic Tool for Acute Appendicitis.

Abstract

Objective: to evaluate the diagnostic accuracy (discrimination) and implementation performance of Alvarado score. Methodology: This cross sectional study was done in Surgerical unit of Bahawal Victoria  hospital Bahawalpur under supervision of consultant Surgeons of department. Study duration was 1 year from March 2018 to March 2019. For quantitative variables like age of patients Mean and SD was calculated, and frequency percentages were calculated for categorical data like gender. Negative appendectomy rate, positive predictive value, negative predictive value, sensitivity, specificity was calculated by using 2-2 contingency table. Results: Total 300patients enrolled in this study, both genders. Alvarado scoring at presentation, 15% (n=45) patients were categorized into Group I. 13% (n=39) patients were included in Group II. While, 72% (n=216) were enrolled in Group III. Diagnostic test was positive in 223 patients. While, acute appendicitis was confirmed histo-pathologically in 160 patients. Gangrenous appendicitis observed in 3 patients. Chronic appendicitis, perforated appendicitis, appendicular abscess, no specific pathology, gangrenous intestine and salpingo-oophoritis was observed as 31, 6, 9, 6,3 and 5 respectively. There were 174 patients true positive, 49 were false positive, 59 were false negative and 18 were true negative. Sensitivity, specificity, negative predictive value and negative predictive value were 74.68% 26.87%, 78.02% and 23.37% respectively. Conclusion: Alvarado scoring system is useful tool in diagnosis of appendicitis in pre-operative period which can be useful for surgeons at any level of health care. According to our study observations Alvarado scoring system has better sensitivity 74.68% but specificity 26.87% which shows that Alvarado scoring system is helpful in diagnosis of appendicitis but not much helpful in preventing negative laparotomies.

Keywords: Right lower quadrant pain, Appendicitis scoring, Faecal peritonitis, Ultrasound abdomen, Perforated appendix.

DOI: 10.7176/JMPB/55-15

Publication date:May 31^st 2019