A study on clinical and laboratory parameters in diagnosing patients with acute appendicitis

Vijay Kannan, S (2013) A study on clinical and laboratory parameters in diagnosing patients with acute appendicitis. Masters thesis, Coimbatore Medical College, Coimbatore.


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INTRODUCTION: Acute appendicitis is one of the more common surgical emergencies with a lifetime prevalence rate of one in seven. The diagnosis of acute appendicitis is purely based on history and clinical examination combined with laboratory investigations such as white blood cell count. However due to variation in clinical presentation and findings making a correct diagnosis of appendicitis is challenging. This leads on to missed diagnosis in about of 20% of patients initially and a negative appendicectomy rate of 14 – 40 %. A delay in diagnosis and subsequent treatment leads on to appendicular perforation and a significant increase in morbidity and mortality. The surgeon's goals are to evaluate patients referred for suspected appendicitis and to minimize the negative appendectomy rate without increasing the incidence of perforation. Various scoring systems have been suggested in different parts which help to diagnose a case of acute appendicitis. Of these Alvarado and modified Alvarado scoring systems are the two most commonly used scoring systems. But these scoring systems were developed for the western population and they lack sensitivity and specificity when used for our population. Other scoring systems mentioned in literature are the IRA Teicher’s, Fenoy’s and Ohmanns scoring system. A new scoring system named RIPASA scoring system has been developed which is more applicable for the south asian population. The laboratory investigations namely white blood cell count (WBC), Creactive protein (CRP) and erythrocyte blood sedimentation rate (ESR) are useful in diagnosing acute appendicitis. But for the diagnosis of perforated appendicitis there is no laboratory investigation that can be used as a marker. Until recently it is stated that perforated appendicitis has been associated with hyperbilirubinaemia. This study proposes to compare the various scoring systems in diagnosing a case of acute appendicitis and to suggest a scoring system which is suitable for our population. This study also intends identify any markers for the preoperative diagnosis of appendiceal perforation. AIMS OF THE STUDY: 1. To compare the sensitivity, specificity, positive predictive value and negative predictive value of various scoring systems namely, Alvarado, Modified Alvarado scoring system (MASS), Teicher, Fenoy, Ohmann and RIPASA scoring system. 2. To propose and suggest a new scoring system which is more suitable for our population and compare it with other scoring systems. 3. To identify an appropriate marker for the preoperative diagnosis of appendicular perforation. MATERIALS AND METHODS: Study area: Coimbatore Medical College Hospital (CMCH), Coimbatore. Study Population: Patients admitted in CMCH with symptoms suggestive of acute appendicitis and taken up for appendicectomy. Inclusion criteria: 1. Patients scheduled for appendectomies for acute appendicitis at the emergency unit of our institution. 2. Patients older than 12 years of age. Exclusion criteria: 1. Patients younger than 12 years of age. 2. A documented history of viral hepatitis, chronic liver disease and haemolytic diseases. 3. Patients preoperatively diagnosed as appendicular abscess. 4. Pregnant women. Study period: 12 months (September 2011 to August 2012). Sample size: All patients eligible by inclusion and exclusion criteria are to be included in the study. Study design: A cross sectional observational study is to be conducted on patients admitted in CMCH for appendicectomy. Informed consent will be taken from each respondent. Study tools: Scoring Systems to be used are pre tested Alvarado scoring system, Modified Alvarado scoring system (MASS), Teicher’s score, Fenoy’s score, Ohmanns scoring system and RIPASA scoring system. CONCLUSION: From this study it is very well understood that each scoring system is specific to its own population. In our population (patients presenting at Coimbatore medical college hospital) all the scoring systems have been compared and it is found that RIPASA scoring system and Teicher’s score have got the best sensitivity and negative predictive value while Fenyo’s scoring system is more specific and has the highest positive predictive value. Ohmann’s scoring system has the best diagnostic accuracy among other scoring systems. The combined predictor score which has been developed from various possible predictors has got a sensitivity, specificity, positive predictive value, negative predictive value comparable with the highest value in each category. This score has the best diagnostic accuracy when compared to other scoring systems in our population. This scoring system is formed in such a manner that it can be used in secondary care hospitals where there is minimal facilities for investigations. Its simplicity makes it easy to remember.

Item Type: Thesis (Masters)
Uncontrolled Keywords: acute appendicitis ; clinical ; laboratory parameters ; diagnosing patients.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 08 Jun 2018 18:47
Last Modified: 08 Jun 2018 18:47
URI: http://repository-tnmgrmu.ac.in/id/eprint/8348

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