Management of Appendicitis in a District General Hospital: The Potential Role of the Alvarado Score in Use of Investigation – Ultrasound, CT or Laparoscopy

Hamer J*, Swati B and Deepak Singh R

Department of General Surgery, New Cross Hospital, UK

^*Correspondance to: Jack Hamer 

 PDF  Full Text DOI: 10.25107/2474-1647.3539

Abstract

Background: Appendicitis is often the primary diagnosis considered when patients present with acute right iliac fossa pain. Our primary aim assessed the diagnostic accuracy of ultrasound for acute appendicitis, including determining the role of Alvarado scoring, C-Reactive Protein (CRP) and Leukocyte count in directing subsequent management. Materials and Methods: A retrospective analysis of all patients undergoing an appendicectomy over a 12-month period was performed. Patients having a pre-operative ultrasound scan were divided into three categories: Normal, inconclusive, or Acute Appendicitis (AA) and compared to histological reports. Symptomatology and biomarkers were used to calculate the Alvarado scores. Statistical analysis for ultrasonography, CT and diagnostic laparoscopy were also calculated. Results: 226 patients underwent a laparoscopic appendicectomy. 77 patients had a pre-operative ultrasound, with 29 reported as AA, 15 as inconclusive, and 33 as normal. Sensitivity, specificity, positive and negative predictive value of ultrasound was 63%, 73%, 79% and 59% respectively. Specifically for males it was 57%, 100%, 100% and 33%. For females it was 67%, 70%, 67% and 70%. CT had values of 100%, 50%, 90% and 100% and laparoscopy 100%, 23%, 86% and 100 %. Alvarado scores of ≥ 6 and ≥ 7 in males and females indicated surgical intervention. Scores ≤ 4 and ≤ 6 suggested pre-operative imaging. Biomarkers could not permit a similar stratification in relation gender (P=0.07). Conclusion: Ultrasound aids in confirming appendicitis in males with strong clinical suspicion. With females it is equivocal in confirming or excluding appendicitis. Alvarado scoring may help direct best management, either through investigation or direct to surgery.

Keywords

Cite the article

Hamer J, Swati B, Deepak Singh R. Management of Appendicitis in a District General Hospital: The Potential Role of the Alvarado Score in Use of Investigation – Ultrasound, CT or Laparoscopy. Clin Surg. 2022; 7: 3539..