Clinical Study for Efficacy of Different Diagnostic Tools for the Diagnosis of Acute Appendicitis PC01-PC04
Dr. Ranendra Hajong,
Associate Professor, Department of General surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong-793018, Meghalaya, India.
Introduction: Acute Appendicitis (AA) is one of the most common causes of surgical abdominal pain and can be confused with other diseases due to atypical presentations of the disease. So, to aid in the diagnosis the various scoring systems and radiochemical investigations are in use such as Modified Alvarado Score (MAS), Ultrasonography (USG) of abdomen, Computed Tomography (CT) scan of abdomen and serum bilirubin levels.
Aim: To study the diagnostic efficacy of MAS, USG of abdomen, CT scan of abdomen and serum bilirubin level for the diagnosis of AA.
Materials and Methods: This was a prospective observational study conducted in the North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India. A total of 72 patients with the clinical diagnosis of AA participated in the study. The patients were subjected to MAS, USG of abdomen; serum bilirubin level and Contrast-Enhanced Computed Tomography (CECT) scan on admission. Sensitivity, specificity, positive predictive value and negative predictive value for each test were found. Final diagnosis was confirmed histopathologically. Descriptive statistics data were calculated using SPSS version 22.0.
Results: Sensitivity was highest for USG 42 (80.77%) out of 52. Specificity was highest for CT scan 18 (90%) out of 20, when target sign was found positive in the patient and also in cases of serum bilirubin 18 (90%) out of 20 when the patient had perforated appendicitis. Otherwise the overall diagnostic accuracy of USG was the highest 47 (65.28%) of 72.
Conclusion: Diagnosis of AA is still challenging as the overall sensitivity or specificity of scoring system as well as radiochemical analysis is still very poor.