alvarado scoring system in preoperative diagnosis of acute appendicitis at kr hospital, mysore

112 Pages·2014·1.84 MB·English

ALVARADO SCORING SYSTEM IN PREOPERATIVE
DIAGNOSIS OF ACUTE APPENDICITIS AT K.R HOSPITAL,
MYSORE - A CLINICO PATHOLOGICAL CORRELATION
DISSERTATION
By
Dr. NISCHAL RAJ.L
SUBMITTED TO THE
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,
BANGALORE
IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SURGERY INGENERAL SURGERY
UNDER THE GUIDANCE OF
DR.M.A.BALAKRISHNA,MS
DEPARTMENT OF GENERAL SURGERY
MYSORE MEDICAL COLLEGE & RESEARCH INSTITUTE, MYSORE
APRIL 2014
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ACKNOWLEDGEMENT
Human venture is not a lone effort but more often is collective endeavour, so
is this present study. It is my duty to acknowledge the help and guidance I have
received from various people in writing this dissertation.
I am immensely thankful to my teacher and guide Dr. M.A. Balakrishna.,MS,
Professor, Department of General Surgery, Mysore Medical College & Research
Institute, Mysore for having permitted me to undertake this study and for his able
guidance, suggestions and constant encouragement throughout the preparation of this
dissertation who has been the propelling force behind this work. His temperament has
been marvelous.
It gives me immense pleasure to express my gratitude and respect to Dr.
Mujtahid Ahmed Shariff., H.O.D, Professor Department of Surgery, Mysore
Medical College & Research Institute, Mysore for his inspiring support, guidance and
encouragement. He has been a tremendous motivation.
I wish to thank Dr. Hanumanthappa H., Dean & Director, MMC & RI,
Mysore for his inspiring support and constant encouragement throughout the
preparation of this dissertation.
I wish to thank Dr. B.G. Sagar., Medical Superintendent of Krishnarajendra
Hospital, MMC & RI, Mysore for his inspiring support.
I wish to thank Dr. M.A. Shekar, Scientific Committee Chairman and its
members for allowing me to conduct this study.
I also wish to thank my assistant professors Dr. Ravikumar. G.V, Dr.
Balsubramanya K.S and Dr. Ramachandra M.L for constant support and guidance.
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ABSTRACT
Acute appendicitis is one of the commonest surgical emergencies. Simple
appendicitis can progress to perforation, which is associated with a much higher
morbidity and mortality, and surgeons have therefore been inclined to operate when
the diagnosis is probable rather than wait until it is certain. Routine history and physical
examination still remain most practical diagnostic modalities. Absolute diagnosis of course is
only possible at operation and histopathological examination of the specimen.For this
reasonrate of negative appendicectomy as reported in the world literature varying from 20–
40% with its associated morbidity of around 10%. Surgeons have been resorting to
various scoring systems to aid in diagnosis and operative decision making.
Aims and objectives:
1) To evaluate the efficacy of Alvarado Scoring System as a pre-operative diagnostic
tool in acute appendicitis, in correlation with operative and histopathological
findings.
2) Role of Alvarado Scoring System in cutting down the rate of negative
appendicectomy without increasing morbidity and mortality.
Methodology:
A study of 100 patients presenting with pain abdomen and diagnosed
provisionally as acute appendicitis, admitted in surgical department in K.R. Hospital,
Mysore. Depending on individual presentation, a score was calculated for each case,
from 8 values (based on Alvarado scoring system).
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 Group 1 - Those patients with scores of >/= 7-10 underwent
Appendicectomy.
 Group 2- Those patients with scores of 5-7 who were thought on clinical
grounds to require Appendicectomy, it was performed.
 Group 3- Those patients with a score of <5 were observed and managed
conservatively and reassessed.
The results of Alvarado scoring system, on table operative findings and HPE,
were reviewed.Reliability of scoring system was assessed by calculating negative
appendicectomy rate, sensitivity and positive predictive value.
Results and Observations:
In the present study we had 100 cases of which 59 were males and 41 were
females.
Total No. of male patients were 59. Patients with score 7-10 were 48; with
score 5-6 were 9 and with score < 5 were 2.
Total No. of female patients were 41. Patients with score 7-10 were 29; with
score 5-6 were 9 and with score <5 were 3.
In the study 95 were operated and acute appendicitis was found in 80 patients
which included 30 females and 50 males.
A total of 95 patients with score of 7-10 and 5-6 were operated. Out of 95
operated patientsacute appendicitis was found in 80 patientswhich included 30
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females and 50 males. Patients with score <5 were kept under observation and none of
the patients required surgery.
Among males with score of 7-10, 48 patients were operated and 46 were found
to have inflamed appendix. Among females with score of 7-10, 29 patients were
operated and 27 were found to have inflamed appendix.
The sensitivity of Alvarado scoring system was 91.25%. The positive
predictive value of scoring system was 94.8% and was higher in males. . The negative
appendicectomy rate in this study was 15.78% (male 12.28% and female 21.05%).
Conclusion:
The Alvarado scoring system is a fast, simple, reliable, non-invasive,
repeatable and safe diagnostic modality without much extra expense and
complications. It has greater sensitivity and positive predictive value in diagnosing
acute appendicitis and it reduces the rate of negative appendicectomy.
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