Posted in Volume 15 - Number 4
SYED NIZAMUDDIN, KHURSHEED AHMAD SAMO, MUNAWAR HUSSAIN MANGI, SHAFIQ UR REHMAN
ABSTRACT | Full Text PDF
OBJECTIVE: To determine that Clinical use of a diagnostic score improves decision making in acute appendicitis.
STUDY DESIGN: Descriptive case series.
SETTING Surgical units 4 and 5 of Civil Hospital Karachi
METHODOLOGY: All patients presented consecutively through emergency department with complaints of right iliac fossa pain were included. All the relevant information was recorded in a Performa. These patients were divided in to 3 groups according to Alvarado Score. Group I comprised of patents with score 7 or more, all were admitted to the surgical ward and operated for Appendicectomy. Group II included patients with Alvarado score 5-6; they were admitted to ward for observation for 24 hours. Those improved were sent home while those in whom symptoms aggravated and score rose were operated for Appendicectomy. Group III included patients with score 1-4. They were evaluated in emergency department, given symptomatic treatment and sent home with directions to report if symptoms aggravate or persist.
RESULTS: Out of 201 patients, 164 (81.6%) were operated with the diagnosis of acute appendicitis, (94 male and 70 female) among them 140(85.4%) had acute appendix; (83male and 57female). Negative appendicectomy was done in 24 patients (14.6%) 15 male and 9 female. The positive predictive value of Alvarado score was 85.4 %.( male 88.3% and female 81.4%)
CONCLUSION: Alvarado score is a helpful tool for the admission criteria and further management in order to reduce unnecessary admissions and to reduce the morbidity and mortality of acute appendicitis. It is easy, simple and cheap and has special place in developing countries where costly diagnostic facilities like Ultrasound, CT scan. MRI and C reactive protein estimation is not available in majority of hospitals
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