A CLINICOPATHOLOGICAL STUDY TO ESTABLISH THE CORRECTNESS OF THE DIAGNOSIS OF ACUTE APPENDICITIS IN CASES OF ACUTE RIGHT LOWER QUADRANT PAIN OF ABDOMEN

BACKGROUND Acute appendicitis is a common surgical condition that requires prompt diagnosis in order to minimize morbidity and avoid serious complications. Accurate identification of patients who require immediate surgery as opposed to those who will get benefit from active observation is not always easy. 1 Therefore, several scoring systems have been devised to aid decision making in doubtful cases, including Ohmann, Alvarado, Eskelinen and several others. These scores utilize routine clinical and laboratory assessment, thus being simple to use in a variety of clinical settings. We wanted to study the various clinical presentations of patients with suspected acute appendicitis, evaluate diagnostic accuracy of modified Alvarado score and Ohmann score in co-relation to histopathology report for diagnosis of acute appendicitis. To determine the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the individual scoring systems and ultrasonography and the same parameters when they are combined together. METHODS The present descriptive study was undertaken at Hi Tech Medical College, Bhubaneswar, Odisha. During the period of October 2016 to November 2018. After thorough clinical examination and routine blood investigation, every patient was allotted modified Alvarado score and Ohmann score. Ultrasonography, intraoperative findings, histopathological examination were done. Sample size was taken for convenience. RESULTS US had a sensitivity of 90.32%, specificity 80.95%, PPV 87.5%, NPV 85% and diagnostic accuracy of 86.54%. Alvarado score gives sensitivity 90.32%, specificity 61.90%, PPV 77.78%, NPV 81.25% and diagnostic accuracy of 78.85%. Ohmann score yields sensitivity 80.65%, specificity 80.95%, PPV 86.21%, NPV 73.91% and diagnostic accuracy of 80.77%. When modified Alvarado score combined with ultrasonographic finding then sensitivity, specificity, PPV, NPV and diagnostic accuracy increases to 96.3%, 100%, 100%, 90% and 97.22% respectively. When Ohmann score also combined with ultrasonographic findings sensitivity, specificity, PPV, NPV and diagnostic accuracy increases to 92.31%, 88.24%, 92.31%, 88.24% and 90.69% respectively. CONCLUSIONS When any of the two scoring systems i.e. modified Alvarado score and Ohmann score was used along with US, it increased the sensitivity, specificity, PPV, NPV, diagnostic accuracy and reduced the negative appendectomy rates. So, combination of scoring system with ultrasonography is very helpful to correctly diagnose acute appendicitis.