Title: Preoperative Diagnosis of Acute Appendicitis: Evaluation of Modified Alvarado Scoring System versus Ultrasonography
Authors: Dr Jawad Kadhim S. Al-Dhahiry. MD, Dr Hassan Khalil Melek. MD, Dr Tareq Khalid Abduljabbar. MD, Dr Mustafa Farhan Yaly .MB.CH.B
DOI: http://dx.doi.org/10.18535/jmscr/v4i8.28
Background: an early preoperative diagnosis of acute appendicitis is ocasionally very challenging. Clinical examination and Ultrasonography (USG) are very useful tools to confirm early preoperative diagnosis of acute appendicitis. Objective: Evaluation of MASS and USG in preoperative diagnosis of acute appendicitis. Design and Setting: This is a prospective Cohort study performed in AL-Karama Teaching Hospital/ Medical College / University of Wasit /Iraq. Patients and Methods: A total of 110 patients complaining of Right Lower Quadrant (RLQ) acute abdominal pain with high suspicion of acute appendicitis ,were included in this study during the period from September 2015 to June 2016.They were preoperatively assessd by Modified Alvarado Scoring system (MASS) and abdominal USG. They were appendectomised. The removed appendicies were histopathologically examined. MASS, USG and histopathologic results were statistically analysied. Results: They were 67 males (60.1%) and 43 females (9.1%). Mean±SD of patients' age was 23.3±11.9 years. The post-operative histopathologic examination proved that 98 (89 %) out of 110 patients had acute appendicites while the remaining 12 (11%) patients had normal appendices. Sensitivity, specificity, Positive Predictive (PPV) ,Negative Predictive Value (NPV) and accuracy rate of MASS with cutoff point 6 were : 89%, 33%, 91%, 28% and 83 % respectively, P-value = 0.04 .When MASS with cutoff point 7, they were 66.3%, 12.8%, 94.2%, 19.5% and 66 % respectively, P-value=0.03.Sensitivity, specificity, PPV, NPV and accuracy rate of USG were :62%, 91%, 98%, 22% and 65 % respectively, P-value=0.01. Conclusion and Clinical Significane: MASS with cutoff point 6 has high sensitivity and accuracy rate .Despite MASS has a slight increase in negative appendectomies but it improves the early diagnosis and treatment preventing complications of delayed diagnosis such as appendiceal perforation. USG gives dependable findings for early diagnosis of acute appendicitis but, it is an operater dependent needing perfect training. Keywords: Diagnosis of Acute Appendicitis, Modified Alvarado Scoring System (MASS), Ultrasonography, 1. Henna E Sammalkorpi, Panu Mentula, Ari Leppäniemi. A new adult appendicitis score improves diagnostic accuracy of acute appendicitis – a prospective study. BMC Gastroenterology .2014; 14:114. 2. Chan I, Bicknell SG, Graham M. Utility and diagnostic accuracy of sonography in detecting appendicitis in a community hospital. AJR Am J Roentgenol. 2005; 184(6):1809–1812. 3. Mohamed Samir , Mohamed Hefzy , Mohamed Gaber , Khaled Moghazy . Added value of graded compression ultrasound to the Alvarado score in cases of right iliac fossa pain. African Journal of Emergency Medicine .2016.(article was in press ) . 4. Abdelrahim M, Khair R, Elsiddig K O. The Validity of Alvarado Score in Diagnosis of Acute Appendicitis among Sudanese Patients. Surgery Curr Res 6: 2016; 257. doi:10.4172/2161-1076.1000257. 5. Velanovich V, Savata R. Balancing the normal appendectomy rate with the perforated appendicitis rate: implications for quality assurance. Am Surg .1992; 58:264–269. 6. Horzic M, Salamon A, Koplijar M, et al . Analysis of scores in diagnosis of acute appendicitis in women. Coll Anropol . 2005; 29:133. 7. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med .1986; 15:557–564. 8. Jain Ravindra, Jain Anjula. A comparative study of diagnostic accuracy of clinical or other diagnostic modalities, used either alone or combined together in diagnosis of acute appendicitis. Int J Biol Med Res.2015;6(2):4871-4874 . 9. Tamanna MZ, Eram U, Hussain AM, Khateeb SU, Buhary BM. Alvarado score in diagnosis of acute appendicitis. International Journal of Basic and Applied Medical Sciences .2012; 2(1):66-70 . 10. Raja Shekar Jade, Uday Muddebihal M, Naveen N. Modified alvarado score and its application in the diagnosis of acute appendicitis. International Journal of Contemporary Medical Research .2016;3(5):1398-1400. 11. Ramachandra J, Sudhir M, Sathyanarayana B.A. Evaluation Of Modified Alvarado Score In Preoperative Diagnosis Of Acute Appendicitis. Journal of Evolution of Medical and Dental Sciences. 2013November 18;Volume (2)/ Issue (46) :9019-29 . 12. Patel V, Kela M, Prasad S, Gautam AS, Gupta M. Evaluation of modified Alvarado scoring system in diagnosis of acute appendicitis - a prospective study. Int Surg J .2016;3:621-5 . 13. Satyajeet Kumar Singh, Kunal, Chitrangada . Comparative Study of Diagnostic Accuracy of Modified Alvarado Score and Ultrasonography in Acute Appendicitis . IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) V 13, Iss 1 Ver. VII. (Jan 2014), PP 36-40 www.iosrjournals.org 14. Leann E. Linam, Martha Munden . Sonography as the First Line of Evaluation in Children With Suspected Acute Appendicitis. J Ultrasound Med .2012; 31:1153–1157 |0278-4297| www.aium.org. 15. Sayani R, Mustahsan SM, Ali AAM, Anwar M . Role of focused Ultrasound in the diagnosis of acute appendicitis in Pediatric population.Selection of a standard diagnostic criterion . International Journal of Endorsing Health Science Research .2015 March; Volume 3 Issue 1:29-31 . 16. Sahim Qusous , Ala Odeh , Sahel Haddadin ,et al. Correlation between Surgical Alvarado score and histological examination in the assessment of acute appendicitis . Int J Med Invest .2015; vol 5; num 1:1-4. 17. Nasiri et al. Diagnostic values of ultrasound and the Modified Alvarado Scoring System in acute appendicitis. International Journal of Emergency Medicine .2012 ;5:26 . 18. Caren Dsouza , John Martis, Vinay Vaidyanathan . Diagnostic Efficacy Of Modified Alvarado Score Over Graded Compression Ultrasonography. Nitte University Journal of Health Science. 2013 September; Vol. 3, No.3:105-8 . 19. J.P.Dave1, P.K. Dharaviaparmar, G.N. Vaghasiya, M.Vekariya4, S.O.Sankhala. Study of Modified Alvarado Scoring System As A Diagnostic Tool For Acute Appendicitis . Int J Res Med. 2016; 5(1);25-27 . 20. Emmanuel S Kanumba, Joseph B Mabula, Peter Rambau, Phillipo L Chalya. Modified Alvarado Scoring System as a diagnostic tool for Acute Appendicitis at Bugando Medical Centre, Mwanza, Tanzania . BMC Surgery . 2011; 11:4 . 21. Denizbasi A, Unluer EE. The role of the emergency medicine resident using the Alvarado score in the diagnosis of acute appendicitis compared with the general surgery resident. Eur J Emerg Med .2003; 10(4):296–301. 22. Old JL, Dusing RW, Yap W, Dirks J. Imaging for suspected appendicitis. Am Fam Physician .2005 Jan 1; 71(1):71–78. 23. Sun J, Noh HW, Min YG, et al . Receiver operating characteristic analysis of the diagnostic performance of a computed tomographic examination and the alvarado score for diagnosing acute appendicitis: emphasis on age and sex of the patients. J Comput Assist Tomogr 2008, 32(3):386–391. 24. Peixoto RO, Nunes TA, Gomes CA. Diagnostic rates of abdominal ultrasonography in acute appendicitis. Influence of gender, physical constitution, disease time evolution and experience of radiologist. Rev Col Bras Cir. [periódico na Internet] 2011; 38(2). Disponível em URL: http://www.scielo.br/rcbc . 25. Cha S-W, Kim IY, Kim YW .2014 Quantitative Measurement of Elasticity of the Appendix Using Shear Wave Elastography in Patients with Suspected Acute Appendicitis. PLoS ONE 9(7): e101292. doi:10.1371/journal.phone.0101292.Abstract
References