Comparison between Accuracy of Alvarado Scoring and USG Abdomen in Diagnosis of Acute Appendicitis

Introduction- Acute appendicitis is the most common surgical emergency of the abdomen with significant morbidity, which increases with diagnostic delay. Misdiagnosis is not uncommon. In fact, despite diagnostic and therapeutic advancement in medicine, appendicitis remains a clinical emergency and is one of the common causes of acute abdominal pain. Decision making in cases of acute appendicitis poses a clinical challenge specially in developing countries where advanced radiological investigations are not cost effective and so clinical parameters remain the mainstay of diagnosis. Several diagnostic scoring systems have been devised as an aid to the early diagnosis of acute appendicitis and to reduce the incidence of negative appendicectomy. This prospective study was conducted to compare the accuracy of Alvarado Scoring and USG abdomen in diagnosis of Acute Appendicitis in MGM Medical College, Navi Mumbai, during January 2012 November 2013 on 80 patients who presented with right iliac fossa pain Methods This is a prospective study in which 80 pts. with right iliac fossa pain, suspected of acute appendicitis were taken for the study. Detailed examination and investigations were done. These patients were then categorized according to Alvarado score and open/lap appendicectomy was performed. The diagnosis was confirmed by histopathology examination. Results The result of this study showed that high score (7-10) in both males and females had high sensitivity, 97.06 % and 95.45 % respectively. The overall sensitivity rate was 96.43 %, whereas the USG had sensitivity of 88.89 %. The score (5-6) in males and females had sensitivity of 20.0 % and 62.5 % respectively. The overall sensitivity rate in this group was 53.85 % which was quite low than that of USG i. e.85.71 %. Conclusion- From the present study it may be concluded that high scores (7-10) in Alvarado score is dependable aid in early diagnosis of acute appendicitis both in males and females. In females, because of other conditions mimicking appendicitis like pelvic inflammatory disease, ruptured ectopic pregnancy, ultrasonography of abdomen act as a useful tool in ruling out these conditions and therefore avoiding negative appendicectomy. The result of present study showed that a Negative appendicectomy rate was significantly higher in Group 2 (score 5-6), 46.15 %. out of which males had higher rate (60 %) than females (37.5 %). But in Group 3 (score 7-10 the negative appendicectomy rates were quite low (3.57 %). Out of which females had higher rate (4.55 %) than males (2.94 %).