Publication:

Evaluation of accuracy of four clinical scores and comparison with ultrasonography for diagnosis of acute appendicitis

Background The vagaries of presentation and the variability of signs in acute appendicitis are such that even the most experienced surgeons may remove normal appendices or conserve those with perforation. Diagnostic scoring systems and imaging techniques may reduce the number of unnecessary appendectomies.

Methods 75 patients who presented with acute right Iliac fossa pain were analyzed using four different scoring systems. An abdominal ultrasound was also performed when necessary. The results of these scores, USG findings were compared to the intra operative findings and final histopathological report.

Results The Alvarado score had the best positive predictive value with high sensitivity. The Fenyo score was most sensitive for males, whereas the Teicher score was most sensitive for females. The Teicher score was the most specific. The Ohmann score had the highest negative predictive value. Ultrasonography showed a low sensitivity and specificity.

Conclusions There was a 24% negative appendicectomy rate in our study. The Alvarado score is ideal for borderline cases where a quick decision needs to be taken. Ohmann’s score can be used to rule out appendicitis in the casualty setting as it has the best negative predictive value. Fenyo and Teicher’s score with their high sensitivity can be used to reduce the number of negative appendicectomies.