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CC BY-NC-ND 4.0 · Journal of Health and Allied Sciences NU 2013; 03(03): 105-108
DOI: 10.1055/s-0040-1703689
Short Communications

DIAGNOSTIC EFFICACY OF MODIFIED ALVARADO SCORE OVER GRADDED COMPRESSION ULTRASONOGRAPHY

Caren Dsouza
1   Assistant Professor, Department of General Surgery, K. S. Hegde Medical Academy, Nitte University, 3 Deralakatte, Mangalore - 575 018, India
,
John Martis
2   Professor, Department of General Surgery, K. S. Hegde Medical Academy, Nitte University, 3 Deralakatte, Mangalore - 575 018, India
,
Vinay Vaidyanathan
3   Assistant Professor, Department of E.N.T., Father Muller Medical College, Father Muller Road, Kankanady, Mangalore - 575 002, India
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Abstract

Background: Acute appendicitis is one of the commonest surgical emergencies. Despite a life time cumulative risk of nearly 7% its diagnosis remains a challenge. The risks of two primary outcomes must be balanced in the management of presumed appendicitis: perforation and misdiagnosis.The rate of misdiagnosis in certain populations is as high as 40%. Diagnostic aids like modified Alvarado score and ultrasonography can dramatically reduce the negative appendicectomies.

Methods:Data was collected from 60 patients with complains of right iliac fossa pain over a period of 9 months to our hospital. All patients were categorised using the Alvarado score and Graded compression ultrasonography was done. The preoperative and histological findings were compared with the preoperative diagnosis. The collected data was analysed with regards to various parameters like sensitivity, specificity, predictive values and diagnostic accuracy.

Results:In our study of 60 patients, 56 patients underwent appendicectomy out of which a histological confirmation of appendicitis was obtained for 50 patients, giving a negative appendicectomy rate of 12%.

By taking a cut-off point of 7 for the Modified Alvarado score, a sensitivity of 97.56%, specificity of 66.67%, positive predictive value (PPV) of 95.23%, negative predictive value (NPV) of 80% and accuracy of 87.2% were calculated. Using the cut-off point of 6, a sensitivity of 90% specificity of 50%, PPV of 69.23%, NPV of 80% and accuracy of 55.56% were obtained. The sensitivity, specificity, PPV, NPV and accuracy rate of ultrasonography was 92.15%, 88.9%, 97.19%, 66.7% and 85%, respectively.

Conclusion:The presence of a modified Alvarado score > 7 was found to be a dependable aid in the preoperative diagnosis of acute appendicitis. In cases where the score was negative or equivocal, ultrasonography greatly helped in the diagnosis thereby reducing the incidence of negative appendicectomies.

Keywords

Ultrasonography - Acute appendicitis - modified Alvarado score


Publication History

Article published online:
26 April 2020

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