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Evaluation of Utility of Alvarado Scoring System in Diagnosis of Acute Appendicitis at a Tertiary Care Centre of Dakshina Kannada

Shafeek Ashraf, Post Graduate, Department of General Surgery, Yenapoya Medical College, Mangaluru, Karnataka 575022, India. , Kiran T.1 , Shafeek Ashraf2

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New Indian Journal of Surgery 9(3):p 390-392, May-June 2018. | DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.9318.28

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Abstract

Acute appendicitis is the commonest ailment presenting at the department of general surgery. A number of clinical scoring systems have been developed for assessing right lower Quadrant abdominal pain for suspected appendicitis. Many scoring systems like Alvarado score, Lintula score, Eskelinen score, Ohmann score, Christian score and Ripasa score are used for children, adults or mixed populations. Amongst them the Alvarado score is most accepted and commonly used scoring system. We intended to evaluate the utility of Alvarado scoring system in the diagnosis of acute appendicitis at our institution in dakshina karnataka.

Materials and Methods: A prospective longitudinal and observational study was conducted between October 2015 to October 2017 at our institution. The inclusion criteria included patients between 15-60 years groups who presented with Right Iliac Fossa pain clinically suspected to be Acute Appendicitis. Exclusion Criteria included patients with delayed presentation leading to appendicular mass, cases with perforation and children below 15 years of age. The statistical analysis including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were then calculated using histopathology (HPR) as a gold standard investigation.

Results: Out of 100 patient who underwent appendicectomy, 54 patient had showed positive Alvarado score >7 suggesting probability of acute appendicitis, 36 patients whose score was <7 showed positive histopathology report. Hence ALVARADO scoring SYSTEM was found to have sensitivity of 60%, specificity of 90%, positive predictive value of 98%, and negative predictive value of 20% and diagnostic accuracy rate of 63%. In our study the Alvarado score had low sensitivity but high positive predictive value. Conclusion: Alvarado score is simple scoring system which can be utilized to ascertain the diagnosis of acute appendicitis made by clinical and laboratory finding rather than utilizing it as a tool for making diagnosis of acute appendicitis.

Keywords: Alvarado Score; Acute Appendicitis; Sensitivity; Positive Predictive Value.

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DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.9318.28

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