Validation of various scoring systems in diagnosis of acute appendicitis

Ranjith Babu, R (2015) Validation of various scoring systems in diagnosis of acute appendicitis. Masters thesis, K.A.P. Viswanatham Government Medical College, Tiruchirappalli.

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Abstract

NEED OF THE STUDY: Acute appendicitis is a commonly presenting acute condition in emergency department. It needs prompt diagnosis without any delay to avoid complications such as mass, abscess, perforartion and peritonitis which may lead to increase in morbidity and mortality. Incorrect diagnosis may miss the underlying other pathology and also cause unnecessary morbidity. There are various scores available to diagnose acute appendicitis such as: 1) Alvarado score -1986, 2) Samuel score- 2002 (child 4-15 yrs), 3) Tzanaki score (tzanaki et al 2005), 4) Appendicitis inflammatory response score( Anderson & Anderson 2008), 5) Ohmann score (ohmann et al 1995), 6) Lintula score (lintula et al 2005), 7) Fenyo lindberg scoring system (fenyo et al 1997). Many of these scoring systems require radiological and laboratory investigations which are not feasible in all institution, so im chosing modified Alvarado scoring, Ohmann scoring, Eskelinen scoring, which can be done in all institutions with clinical parameters and basic investigations. OBJECTIVES OF THE STUDY: 1. To do observational study of the various diagnostic scoring systems in the diagnosis of acute appendicitis. 2. To compare the sensitivity, specifity of Modified Alvarado scoring, Ohmann scoring, Eskielinen score. 3. To analyse the accuracy of this scoring with HPE report or intra-operative findings. MATERIALS AND METHODS: 1. SOURCE OF DATA: Cases admitted in M.G.M.G.H with suspicion of appendicitis. Patient was monitored and scored by the various diagnostic scoring systems. 2. STUDY DESIGN AND SAMPLING: On a average of fifty cases with provisional diagnosis of acute appendicitis between Sep 2012- Oct 2014. The decision of appendicectomy was taken by the senior surgeon irrespective of the score. INCLUSION CRITERIA: 1) All patients who present at the emergency department with clinical suspicion of acute appendicitis. 2. Age group > 10 yrs - < 70 yrs. 3. Both sexes. 4. Hemodynamically stable patients without concurrent illness. EXCLUSION CRITERIA: 1. Patients with other known causes of pain. 2. Patients undergone previous appendicectomy. 3. Age < 10 yrs. 4. Age > 70 yrs. 5. Hemodynamicallly unstable patients. CONCLUSION: In our study, the better scoring system in the diagnosis of appendicitis based on clinical parameters and simple lab investigation, which is comparable to study conducted by *H.Sitter, S.Hoffmann, J.Hassan, A.Zielkl Et Al Study Langenbeck‘S Archives of Surgery at June 2004, Vol 389.among these scoring system Modified Alvardo had better sensitivity. But its variable in other subgroups according to age and sex variation. The parameters of these three scoring systems are mostly same, but the idea of improving the diagnostic accuracy simply by assigning numeric values to defined signs and symptoms has been a goal. It is well known that sex and age play an important role in the presentation of acute appendicitis. These scoring systems, do not take into consideration different diagnostic weights of each parameter in different subpopulation. No single score may be used alone to dictate or decline surgey, different cut-off points may also be considered for different subpopulation.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Validation ; various scoring systems ; diagnosis ; acute appendicitis.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 06 Oct 2018 02:41
Last Modified: 06 Oct 2018 02:41
URI: http://repository-tnmgrmu.ac.in/id/eprint/9668

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