Combining Abdominal Ultrasound with the Alvarado Score in Acute Appendicitis

Authors

1 Faculty of Medicine, Mansoura University, Resident at General Surgery

2 Professor of General Surgery, Faculty of Medicine for boys - Al-Azhar University (The Principal Supervisor)

3 Lecturer of General Surgery, Faculty of Medicine for boys - Al-Azhar University

Abstract

Background: One of the most frequent reasons for urgent surgery is acute appendicitis. Although prompt diagnosis is essential, most series also report a high rate of negative appendectomy operations. Clinical scoring systems and imaging methods for diagnosing appendicitis are being studied as potential diagnostic parameters for lowering the negative appendectomy rate. Aim: to assess the efficiency of combining abdominal ultrasound with the Alvarado score in correctly identifying cases of acute appendicitis. Patients and methods: The study included 118 patients with clinical suspicion of acute appendicitis. Standardized laboratory tests, a complete medical history, and a physical examination were performed on every patient. All patients also had pelviabdominal US performed by a qualified radiologist, and their Alvarado scores were calculated. Histopathological examination of the specimen from each patient's appendectomy was used as the definitive method of diagnosis. Results: When compared to the histopathological findings, the Alvarado score had a sensitivity and specificity of 67.6% and 61.5 %, respectively, for the diagnosis of appendicitis. The ultrasound accuracy for appendicitis was 80.7%, with a sensitivity of 80.4% and a specificity of 76.9%. The combination of both parameters showed 96.7% sensitivity and 88.2% specificity in diagnosis of acute appendicitis. It also showed PPV and NPV were 89% and 83.3% respectively. Conclusion: The combined use of Alvarado score and ultrasound examination was associated with higher sensitivity and accuracy in diagnosis of acute appendicitis when compared with each modality alone.

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