Evaluation of Modified Alvarado Score and Ultrasonography In Acute Appendicitis:
Siddique K*, Jamil A, Ali Q, Ehsan A, Anwar I, Zafar A**.

Department of Surgery, Unit-II, Holy Family Hospital .

 

*Registrar Surgical Unit-II, Holy Family Hospital ,

 

**Consultant Surgeon and Professor of Surgical Unit-II, Holy Family Hospital .

 

Introduction:   Acute appendicitis is a common cause of right Iliac fossa pain. Clinical signs and symptoms are the important tools that lead to its diagnosis, though radiological investigations have also been used for its diagnosis. In some studies the Modified Alvarado Scoring System (MASS) was helpful in minimizing unnecessary appendicectomies. Hence, we aimed to analyze the Alvarado’s score and Ultrasonography in the diagnosis of acute appendicitis in adults.

 

Patients & Methods:   The study was conducted at Holy Family Hospital, Rawalpindi from Jan. 2006 till Dec. 2006.All  patients aged 12 years and above who were admitted with a provisional diagnosis of acute appendicitis  were included into the study. The study included 267 patients between the ages of 12 and 58 years. They were prospectively evaluated on admission using the Modified Alvarado Score (MAS) along with abdominal Ultrasound to determine whether or not they had acute appendicitis. (Table 1). The decision of surgery was taken on basis of clinical findings by the attending Registrar and the Consultant. The comparison of findings of Modified Alvarado’s Score & Ultrasound was then done with the operative and histopathological findings.

 

Table 1. The Modified Alvarado’s Score.

 

Results:  Out of 267, 220 patients (82.4%) had appendicectomy while 47 patients (17.6%) had no surgery. Amongst the operated patients 119 were male while 101 were female with an average age of 23.5 years. 175 patients (79.5%) had acute appendicitis while 45 patients (20.4%) had normal appendices on histopathology examination. The other operative findings like salpingitis, ovarian cyst and Ileocecal mass were also noted. (Table. 2)  Overall the MAS system showed a sensitivity of 57.8% and a specificity of 78%.Negative appendicectomies were seen more in females than males. For males, the sensitivity was 62.3% and the specificity was 92%. For females the sensitivity and specificity were 52.7% and 65% respectively. Ultrasound was able to diagnose appendicitis in 157 patients (71.3%). The combined results of MAS and Ultrasound showed a combined sensitivity of 74% and specificity of 82%.

 

 

Table 2. The Final Diagnosis.

 

 

 

Conclusion:  The combined diagnostic accuracy of Modified Alvarado score and abdominal ultrasound is found to be helpful in the diagnosis and management of acute appendicitis. Diagnosis of acute appendicitis is virtually confirmed with a score of 7-9 especially in males however, the additional information provided by ultrasound does improve diagnostic accuracy in the case of a negative or equivocal Alvarado score. Diagnostic laparoscopy may help to minimize the unacceptable high false negative rate in women.

Keywords: Modified Alvarado Score, Ultrasound, acute appendicitis, adults.