Haris Vijila Rani, M (2009) Evaluation of Alvarado Scoring in Acute Appendicitis. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Acute appendicitis has been treated surgically for over 100 years, the first appendicectomy being performed by Lawson Tait in May 1880. Despite its high prevalence with the population, accurate diagnosis still remains difficult. The percentage of appendicectomy where appendix is normal (negative appendicectomy) varies between 15 and 50% and post operative complications occur in upto 15 % of these patients. The greatest diagnostic error occurs in women whose symptoms and signs may be caused by many gynaecological conditions. Compared with men, the diagnosis of appendicitis in women is twice as likely to be more incorrect, and the complications of negative appendicectomy vary, from superficial wound infection to adhesions, intestinal obstruction , infertility (due to fimbrial adhesions), right inguinal and incisional hernia and even death. The vermiform appendix is only found in humans, certain anthropoid apes and the wombat, and some surgeons advocate that rather than being a degenerate and vestigial structure, the appendix may be considered specialized and useful in reconstructive biliary, tubal and urologic surgery. Negative appendicectomy therefore robs the patient of a useful asset. The risks of negative appendicectomy, however, must be balanced against the increased morbidity and mortality associated with late diagnosis and perforation. Following perforation, the length of stay in hospital increases, the risk of infertility rises, wound infection rates may treble, post operative intra abdominal collections develop 15 times more frequently, and the mortality of appendicitis (normally quoted as 1%) rises to 8.5%. Therefore, a high negative appendicectomy rate has been regarded as acceptable in the light of severe complications of ‘sitting on a hot appendix ‘and risking perforation. AIM: The aim of this study is to evaluate THE ALVARADO SCORING SYSTEM as a diagnostic tool to aid the early and accurate diagnosis of acute appendicitis. MATERIALS & METHODS: This prospective study was carried out from June 2006 to June 2008 in the Department of Surgery in a single surgical unit 60 patients suspected of acute appendicitis were included in the study. Patients included in this study were haemodynamically stable and were without any concurrent illness. Women were operated after ruling out other gynaecological pathology. Alvarado scoring was done for all patients presenting with right abdominal pain and they were classified into 3 groups: Group I – Clinically typical (Alvarado score >6), Group II – Clinically doubtful (Alvarado score 4-6). Group III – Clinically very unlikely (Alvarado score < 4). RESULTS: Total number of patients who presented with suspected appendicitis : 60 On admission Number of patients with scores >6 : 40, Number of patients with scores 4 - 6 : 9, Number of patients with scores < 4 : 11, Number of patients whose score increased to > 6 during the period of observation : 6, Number of patients who score decreased to < 4 during the period of observation : 3, Number of patients who underwent appendicectomy : 46, Number of patients who did not undergo appendicectomy : 14, Number of patients who had a positive histopathological report suggestive of acute appendicitis : 45, Number of patients who had normal appendix : 1, Number of patients with scores < 4 who subsequently developed acute appendicitis : nil. CONCLUSION: In patients with Right iliac fossa pain, Alvarado score is found to be helpful in the diagnosis and management of acute appendicitis. Diagnosis of acute appendicitis is virtually confirmed with score 7-10 especially in males and should undergo appendicectomy. Patients with score 5-6 must be admitted and scored frequently. Score 1-4 can be discharged unless otherwise indicated. Though the diagnosis of acute appendicitis remains mainly clinical, Alvarado score can be recommended as a helpful tool for the admission criteria and further management in order to reduce unnecessary admissions and to reduce the morbidity and mortality of acute appendicitis.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Alvarado Scoring ; Acute Appendicitis. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 20 Mar 2018 03:32 |
| Last Modified: | 20 Mar 2018 18:13 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6396 |
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