Keywords : appendicitis
Evaluation of Modified Alvarado Score in the Diagnosis of Acute Appendicitis at Baghdad Teaching Hospital
Iraqi Postgraduate Medical Journal,
2012, Volume 11, Issue 0, Pages 675-683
Acute appendicitis is one of the most common causes of abdominal surgical emergencies. It is associated with high morbidity and occasionally mortality related to failure of making an early diagnosis. Modified Alvarado Scoring System is a clinical score which aid in the diagnosis of acute appendicitis.
To evaluate the overall diagnostic value of Modified Alvarado Scoring System in patients with suspected acute appendicitis and to determine gender differences.
Study design and Setting : A prospective study was conducted in the surgical emergency unit of Baghdad Teaching hospital in a period of five months extending from 18th February to 18th July 2011
PATIENTS AND METHODS :
(100) consecutive patients above the age of (14) years old and of both genders with provisional diagnosis of acute appendicitis were subjected to interview questionnaire covering sociodemographic and clinical characteristics revealing 7 variables based on the Modified Alvarado Scoring System , summation of all scores were calculated for each patient before underwent surgery and all operated appendices were sent for histopathology.
The total number of included sample were (100) patients , (57%) were females and (43%) were males , (60%) were in the age group of (15-24) years old , (49%) were admitted to hospital within (6-12) hours after onset of symptoms . (87%) had Modified Alvarado Score of ≥7 (57.5% females, 42.5% males) while (13%) had Modified Alvarado Score of <7 (53.9% females, 46.1% males) . Out of those (87%) patients with Modified Alvarado Score ≥ 7 , (92%) patients had acute appendicitis and (8%) patients had normal appendix on histopathological examination. The negative appendectomy rate for patients with score ≥ 7 was 8.1%. While patients with Modified Alvarado Score < 7 were (13%), only (46.1%) of them had acute appendicitis on histopathological examination giving a negative appendectomy rate of 53.9%. The sensitivity , specificity , accuracy and positive predictive value in males were ( 85.4%) , (0%) ,(81.4%) and (94.6%) respectively while in females were (100%) , (58.3%) , (91.2%) and (90%) respectively .
The overall sensitivity , specificity , accuracy , negative appendectomy rate and positive predictive value were (93%) , (50%) , (87%) , (14%) and (91.9%) respectively .
Modified Alvarado Scoring System is helpful in the diagnosis of acute appendicitis.
Iraqi Postgraduate Medical Journal,
2008, Volume 7, Issue 3, Pages 226-230
Management of acute appendicitis is strictly surgical but acute appendicitis presented as appendix mass could be treated in different ways including using antibiotic treatment regime but these options remains controversial. The aim of this study was to evaluate the role of antibiotic in the conservative management of appendix mass.
The medical records of 1051 patients diagnosed as acute appendicitis at two different teaching hospitals in in Yemen, have been reviewed for the purpose of this study. 516 cases collected from Kuwait University Hospital,(K.U.H.) Sanu'a (between Jan 2005 to Dec 2007 ) and 535 cases collected from Ibn Sina Teaching Hospital ,(ISTH). Mukalla, (between Jan 2007 to Dec 2007). It has been found that 893 cases had urgent operation, and 98 patients diagnosed as suspected non obstructive acute appendicitis and got recovered completely with conservative treatment. On the other hand 60 cases, (5.7%), presented with appendix mass, and have been treated conservatively by distributing them randomly into two selected groups, group A treated with rest + antibiotic, group B treated with rest only and results analyzed prospectively
The 35 appendix mass cases treated at K.U.H, represent (7.5%) ,cases distributed as Group A, had an average hospital stay of Sdays ( ranging from3-7), while group B, had stayed an average of 6.5 days (ranging from3-ll). 25 appendix, mass cases
represent 5.1% at I.S.T.H. Group A. had an average hospital stay of 5.5 days(3-8) ,while group B, had an average of 8 days (3-20). the proportion of appendix mass presented with pyrexia in both groups were 41.6%.
Complications: two cases reported at I.S.T.H with signs &symptoms of recurrent sub acute appendicitis and palpable residual appendix mass, both from group A, refused operation and were treated conservatively with the same regime (antibiotics+ rest) signs and symptoms subsided in few days & discharged. Other complications such as abscess formation or spreading peritonitis were absent.
Interval appendicectomy; all patients were advised to come back in 6 weeks for elective appendicectomy. 6 cases reported at K.U.H, and only 2 at I.S.T.H. All were free from signs & symptoms and they had operation
Conservative treatment for appendix mass is effective and safe, antibiotic, might shorten the resolution time but not essential. Complications is only 3% and represented by recurrent sub acute appendicitis, which responded to conservative treatment. Interval appendicectomy is probably unnecessary and should be reserved for cases with recurrent of signs and symptoms only