ABSTRACT
Acute appendicitis is one of the most common abdominal emergencies encountered in surgical practice. The diagnosis of acute appendicitis is an enigmatic challenge. Several studies have reported a variable diagnostic accuracy with a negative appendicectomy rate varying from 3% up to 20% using combined diagnostic modalities or using Alvarado score alone. The present study was carried out to evaluate the diagnostic efficacy of combined use of Alvarado score and imaging modalities (USG and / or CECT abdomen) for preoperative diagnosis of acute appendicitis.METHODSThe present study was a prospective observational study carried out in a tertiary hospital of a metropolitan city. The study period extended over two years, from January 2016 till December 2018. The study included 118 adults who presented with clinical features of acute appendicitis. Alvarado scoring system based mainly on clinical features was applied and graded. Compression USG was performed on all patients. CECT of abdomen was done in 30 patients having inconclusive results on USG. Appendicectomy was performed on all the patients after the Alvarado scoring and imaging. The histopathological findings of the surgical specimens were noted to confirm the pathological diagnosis. The sensitivity, specificity, PPV, NPV and accuracy of the diagnostic methods were calculated.RESULTSOut of 118 appendicectomies, 104 were found to be positive on histopathology, with an overall 11.86% negative appendicectomy rate. Combined use of imaging with a high Alvarado score (7-10) had a sensitivity of 95.74%, specificity of 100%, accuracy of 95.8%. Combined use of imaging with a low Alvarado score (3-6) had a sensitivity of 89.47%, specificity of 53.8%, accuracy of 82.85%. Alvarado score alone had a sensitivity of 45.19%, specificity of 92.85% and accuracy of 50.8%. USG alone showed a sensitivity of 71.15%, specificity of 71.42% and accuracy of 71.18%. CECT alone had a sensitivity of 88%, specificity of 60% and accuracy of 83.3%.CONCLUSIONSImaging modalities have a valuable role in terms of diagnostic accuracy particularly in cases having low Alvarado score. CECT though expensive is preferable to USG. However, the combined methodology of Alvarado scoring, and imaging is a rational approach for accurate diagnosis preventing surgical complications and minimizing negative appendicectomy rate.
ABSTRACT
Background: Acute appendicitis is mostly considered a clinical diagnosis and many surgeons resort to clinical judgement for deciding its management. Such cases often pose a diagnostic dilemma and result in significant negative exploration rates. Appendicitis Inflammatory Response (AIR) score, designed in 2008, is a validated clinical scoring system which has outperformed the well-known Alvarado scoring system. This study evaluates the risk stratification of patients as per AIR scores, correlation with the post-op histopathological examination (HPE) diagnosis to calculate the negative appendicectomy rate and to evaluate the diagnostic performance of this scoring system. Method:This is a prospective observational study carried out between Nov 2016 and May 2018, on 150 cases of acute appendicitis that underwent surgical management. Result: This study data revealed a negative appendicectomy rate of 9.33 %. Statistical analysis showed that scores of 9 - 12 has great accuracy for diagnosis, with a specificity of 100 % and positive predictive value of 1.0 whereas low scores of 0-4 potentially identify cases who do not require surgery. Conclusion:The AIR score is an accurate diagnostic tool when a score of 9 is taken as cut-off. Management algorithms based on AIR score have the potential of reducing negative appendicectomy rate by correct identification of those who don't require surgery.
ABSTRACT
@#Background: Acute appendicitis is one of the most common surgical emergencies. However, its proper diagnosis is complicated. This study aims to evaluate the ability of the neutrophil-to-lymphocyte ratio (NLR) to diagnose acute appendicitis in pre-operative state. Methods: Histopathological examination of appendicectomies conducted between 2016 and 2017 in Melaka Hospital, Malaysia were traced and categorised into three groups: i) G1 (normal appendix), ii) G2 (acute appendicitis) and iii) G3 (perforated appendicitis). The reports were randomised and a total of 338 samples were collected. NLR values were compared between the three different groups and analysed. Results: The median values of NLR for G1, G2 and G3 were 2.37, 5.25 and 9.27, respectively. We found a statistically significant difference in NLR between G1 and G2 (P < 0.001), and G2 and G3 (P < 0.001). The diagnostic values of NLR for acute appendicitis and perforated appendicitis were 3.11 (sensitivity: 75.23%, specificity: 68.70%) and 6.17 (sensitivity: 76.32%, specificity: 58.72%), respectively. There was a substantial correlation between NLR and disease severity, and a moderate correlation between NLR and duration of admission. Conclusion: NLR, with a sensitivity of 75.23% and specificity of 68.70%, is a useful and reliable adjunct in diagnosing acute appendicitis. Hence, it will help in reducing the rate of negative appendicectomies.