Year :
2023
| Month :
February
| Volume :
17
| Issue :
2
| Page :
PC05 - PC08
Diagnosis of Acute Appendicitis using Alvarado Score, Ultrasound Abdomen, and C-Reactive Protein in Different Combinations: A Prospective Observational Study
Laxmi Narayan Meena, Vivek Rajan, Naresh Kumar Mangalhara, Deeksha Mehta
1. Professor, Department of General Surgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India.
2. Senior Resident, Department of General Surgery, Max Hospital, Saket, New Delhi, India.
3. Associate Professor, Department of Radiodiagnosis, SMS Medical College and Hospital, Jaipur, Rajasthan, India.
4. Assistant Professor, Department of General Surgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India.
Correspondence Address :
Deeksha Mehta,
33, (West) Mangal Vihar Extension, Jaipur, Rajasthan, India.
E-mail: deeksha_doc@yahoo.co.in
Abstract
Introduction: Appendicitis is the most commonly encountered surgical emergency worldwide. Numerous diagnostic methods, including clinical scoring systems, radiological modalities, and laboratory markers have been suggested over time to diagnose appendicitis correctly, but a Negative Appendectomy Rate (NAR) of 20-30% is still maintained.
Aim: To determine the effect of using all three modalities together i.e., a clinical modality {The Alvarado Score}, a radiological modality {Ultrasound (US)}, and a laboratory parameter {C-Reactive Protein (CRP)} in diagnosing acute appendicitis.
Materials and Methods: This was a hospital-based, prospective observational study, carried out in the Department of General Surgery, SMS Medical College, Jaipur, Rajasthan, India, from March 2019 to June 2020. The three diagnostic modalities were arbitrarily categorised into different combinations: Combination 1: Alvarado score ≥5 with C-Reactive Protein (CRP) ≥0.8; Combination 2: Alvarado score ≥5 with US grade 4 with CRP ≥0.8; Combination 3: Alvarado score ≥5 with US grade 4 with CRP ≥4); and the individual modalities i.e., the alvarado score and the US abdomen were also categorised into four categories each. Each of the individual modalities along with their different combinations were tested for their sensitivities, specificities, Positive and Negative Predictive Values (PPV, NPV) etc. Chi-square and t-test, sensitivity test and Receiver Operating Characteristic curve (ROC) and, Analysis of Variance (ANOVA) was used.
Results: Total 200 cases were analysed in this study with mean age 32.33±15.78 years. Alvarado score had a sensitivity and specificity of 95.83% and 75%, respectively. US had a sensitivity and specificity of 71.35% and 75%, respectively while CRP had the highest sensitivity with 98.96%, but very low specificity (37.5%). The sensitivity, specificity, PPV and NPV of the combination 1 were found to be 98.96, 37.50, 97.44, 60.00, and of combination 2 was found to be 70.83, 87.50, 99.27, 11.11 and for combination 3 was 56.77, 100, 100, 8.79, respectively. Combination 2 also had the highest Area Under Curve (AUC) in Receiver Operating Characteristic (ROC) curve.
Conclusion: The Combination 2 of three modalities proved to be the best diagnostic tool in the present study. It can pave the way, for a better diagnostic scoring system and future studies in this field.
Keywords
Appendicitis scoring systems, Diagnostic modalities, Negative appendectomy rates
DOI and Others
DOI: 10.7860/JCDR/2023/56469.17497
Date of Submission: Mar 18, 2022
Date of Peer Review: Jun 01, 2022
Date of Acceptance: Dec 05, 2022
Date of Publishing: Feb 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 05, 2022
• Manual Googling: Dec 01, 2022
• iThenticate Software: Dec 03, 2022 (11%)
ETYMOLOGY: Author Origin
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