Description

Abstract

Background: The diagnosis of acute appendicitis, one of the most common causes of acute abdomen till date, still remains a tough one. The decision about its management is complex and it involves surgical procedure utilizing technical, financial and human resources. A quick and accurate diagnosis is extremely important to  proceed with an  early appendicectomy  either to prevent complications or to adopt conservative management to avoid unnecessary negative exploration , which may even lead to increased morbidity.Modifiued Alvarado Score is the commonest scoring system used to diagnose acute appendicitis among several other scoring methods. In the present study we planned to estimate the predictive accuracy of Modified Alvarado Score and a newly developed Appendicitis Inflammatory Response Score (AIR Score)against the reference standard of histopathology in acute appendicitis.

Material & Methods: Data from all patients admitted with a suspected appendicitis and underwent appendicectomy were collected from the case records and their Modified Alvarado Score and AIR score were calculated.  Those patients who were treated conservatively were excluded and final diagnosis of appendicitis is confirmed by presence of trans mural inflammatory infiltrate on histopathology of the appendicectomy specimen. Sensitivity, Specificity, Positive Predictive value, Negative predictive Value and Diagnostic Accuracy were calculated for both scores and the predictive accuracy were compared using ROC curves and Area Under the Curve (AUC).

.Results: A total of 345 patients were included in this study. Sensitivity,Specificity,Positive Predictive Value ,Negative Predictive Value and Diagnostic Accuracy of Modified Alvarado Score were 70.1%,96.8%,99.5%,24.2% and 72.5% respectively. The newly developed AIR Score showed a Sensitivity of 73.9%, but Specificity and Positive Predictive value100%, Negative Predictive Value of 27.4% and a Diagnostic Accuracy of 76.2%. Kappa statisticsshowed significant higher reliability for AIR Score(0.337) than Modified Alvarado Score (0.284). The predictive validity assessed by AUC was higher for AIR Score (0.987) compared to Modified Alvarado Score (0.956).

Conclusion: Appendicitis Inflammatory Response Score has showed better Predictive Accuracy than Modified Alvarado Score in diagnosing acute appendicitis and can be used as a more reliable tool in the diagnosis of acute appendicitis..

Key words: Acute appendicitis, Modified alvarado score, Appendicitis inflammatory Response score, Predictive accuracy.