A Study on Usefulness of Modified Alvarado Score in Acute Appendicitis Incorporating Ultrasonogram

BACKGROUND: Acute appendicitis is the most conmon surgical cause of emergency laparotomy. Despite more than 100 years of experience, accurate diagnosis still evades the surgeon. The rate of negative appendicectomy has been reported to be between 20 and 30%. Surgeons have been resorting to various scoring systems to aid in diagnosis and operative decision making. AIMS AND OBJECTIVES: The aim of this study is to review the usefulness of modified Alvarado scoring system and to evaluate its feasibility and value as an aid to surgical diagnosis and in reducing the number of negative laparotomies. METHODOLOGY: A study of 100 patients who were suspected to have acute appendicitis admitted in PSG Medical College & Hospital under various surgical units was conducted during a period from June 2010 to June 2011. The Modified Alvarado score was compared with the USG and histopathological report. The results were analyzed and tabulated according to age, sex, Modified Alvarado preoperative score, Ultrasound imaging and histopathological report. RESULTS AND OBSERVATIONS: In our study males were predominant in number, in the ratio of 1.7:1 with females. The overall sensitivity of Modified Alvarado score was 94%. This study showed ultrasound to have sensitivity of 86%, specificity of 75% and positive predictive value of about 86%. CONCLUSION: Modified Alvarado scoring system significantly reduced the rate of negative appendicectomy. It can be applied in routine practice, even in district general hospitals with minimal laboratory facilities. It has greater sensitivity in adult males than in females