A STUDY ON DIAGNOSTIC UTILITY OF MODIFIED ALVARADO SCORING SYSTEM AND ULTRASONOGRAPHY FOR ACUTE APPENDICITIS AND THEIR CORRELATION WITH HISTOPATHOLOGY

Abstract

Acute appendicitis is one of the commonest causes of appendicitis and is often and mainly diagnosed
based on clinical examination. Diagnostic tools like ultrasonography (USG) and various scoring
systems based on clinical and laboratory investigations are increasingly used in order to improve the
accuracy of diagnosis and lower the chances for false negative reports on appendicectomy. Modified
Alvarado Scoring System (MASS) is one of the commonest used scoring modalities for acute
appendicitis in the present times. The present study is an attempt to investigate the diagnostic utility of
MASS by confirming the results by USG and histopathological findings.
The study was conducted in the department of Surgery, Heritage IMS, Varanasi, from May 2018-June
2020. All 80 patients were categorised into three groups namely Group A, Group B and Group C based
on MASS. These patients were subjected to USG followed by appendicectomy. Surgically removed
appendices were taken up for histopathology examination. The results were tabulated and descriptively
analysed.
The MASS was 1-4, 5-6 and 7-9 in 7.5%, 15% and 77.5% of patients respectively. The most common
symptom was migratory pain (91.5%) followed by tenderness (87.3%) and nausea or vomiting
(81.5%). On histopathological examination 8.7% of removed appendix were found to be normal. The
MASS is used extensively with a sensitivity and specificity of 95.1% and 78.9% while for USG it was
found to be 90.1% and 63.1% respectively. The positive predictive values for MASS and USG were
93.5% and 90.1% while negative predictive values were respectively 61.1% and 63.2%.
Alvarado scoring system is simple and easy non-invasive diagnostic tool to diagnose acute
appendicitis, which together with USG increases the diagnostic accuracy and decreases the rate of false
positive cases to be taken up for appendicectomy.