Study of Predictive Value of Clinical, Labaoratory and Radiological Data in the Diagnosis of Acute Appendicitis

Abstract

Acute appendicitis, though one of the commonest emergencies in surgical practice. Failure of an early diagnosis could lead to the increased risk in its morbidity and mortality. However a negative appendectomy rate of about 25% is described in the surgical literature. This study was performed to evaluate the usefulness of commonly used laboratory tests like leucocyte count, Creactive protein and use of diagnostic scores like Alvorado score along with radiological imaging modalities to diagnose acute appendicitis and decrease negative appendectomies rates. Misdiagnosis and delay in surgery can lead to complications like perforation and finally peritonitis. METHODS: This study was done in Shadan Teaching Hospital with 200 patients of acute right iliac fossa pain including both genders and all ages. Out of 200 patients, 40 patients were managed conservatively and 160 patients were operated. Clinical evaluation done using Alvorado scores and radiological imaging like ultrasound and plain X-ray of abdomen before operation. Subsequently, histopathological findings of appendix specimen were compared with preoperative tools and results were noted. STATISTICAL ANALYSIS: The data were entered and analyzed using Statistical Package for Social Science (SPSS) version 14.0. The p value was taken as significant when less than 0.05. RESULTS: In proven acute appendicitis, both WBC count & serum CRP levels were raised. WBC count showed 80% sensitivity & 67% specificity in diagnosis. Alvorado score proved helpful to diagnose complicated appendicitis with significant high scores. Ultrasonography of Abdomen had accuracy of only 58.2% in diagnosis. CONCLUSIONS: Alvorado scoring method proved helpful in decision making for operative intervention in acute appendicitis.

Normal Total Leukocyte Count in Patients Despite Acute Appendicitis Clinically and Preoperatively

“…Misdiagnosis or conservative treatment mostly lead to complications like perforation of lump formation. [5][6][7] CRP is an inflammatory marker quietly increased or raised in inflammatory conditions like acute appendicitis. 8 Normal CRP ranges 3.5 to 5.…”