A one year prospective study to compare and evaluate diagnostic accuracy of modified Alvarado score and ultrasonography in acute appendicitis, in adults.

OBJECTIVES: To compare and evaluate diagnostic accuracy of modified Alvarado score and ultrasonography in co-relation to histopathology report for diagnosis of acute appendicitis.

METHODOLOGY: A prospective study of the patients who underwent appendectomy for suspected acute appendicitis at K.L.E.S. Hospital and M.R.C. Belgaum. The clinical, radiological and ultrasonogrpahic data of 60 patients with suspected appendicits was collected. These patients were evaluated by modified Alvarado here and ultrasonographically, which was correlated with histopatholocial finding.

RESULTS: Out of 60 patients, 38.33% had acute appendicitis. 40% had modified Alvarado score ≥ 7 and 38.33% patients were ultrasonographically positive. In the present study, modified Alvarado score has sensitivity of 78.26%, specificity 83.78%, positive predictive value 75.00%, negative predictive value 86.11%, diagnostic accuracy 81.00% false positive error rate 16.22% and false negative error rate 21.74%. Ultrasonography had sensitivity of 82.61%, specificity of 89.19%, positive predictive value of 82.61, negative predictive value of 89.19.Diagnostic accuracy of 86.67%, false positive error rate of 10.81%, false negative error rate of 17.39%. When modified Alvarado score and ultrasonography were positive, 17 true positive cases and no false positive cases. The false negative cases in modified Alvarado score were five. When it was combined with ultrasonography the false negative cases reduced to two that is 60% reduction in false negative cases.

CONCLUSIONS: Modified Alvarado score is useful tool in clinical decision making. When compared with ultrasonography neither one is advantageous. However, additional information provided by ultrasonography improves diagnostic accuracy.