Evaluation of the usefulness of modified alvarado scoring system regarding early diagnosis of acute appendicitis and in reduction of negative appendicectomies at Kenyatta National hospital: a prospective study
Abstract
AIM
The aim of the study was to evaluate the impact of the modified Alvarado score on the
negative appendicectomy rate in acute appendicitis.
SETTING
KNH emergency department, general and paediatric surgical units, Nairobi, Kenya .
MATERIALS AND METHODS
A prospective study was undertaken between June 30th, and December 30th, 2004 that
It
included 116 patients who presented with a suspicion of acute appendicitis and
underwent apendicectomy. All the patients were examined and a sample for haemogram
taken at the emergency department to facilitate the scoring. The patients were then
followed up to the ward a decision to operate on them was made independent of the
score, but based on the operator's clinical judgment. At surgery, all the 116 patients had
their gross intra-operative findings noted, specimen taken for histopathological reporting.
The histopathological finding~ were used to verify the true diagnosis of acute
appendicitis.
RESULTS
A total of 116 patients aged between seven and fifty-five years with an average age of
twenty-seven point zero one (27.03 (9.87) years had appendicectomy and specimens
taken for histopathological analysis. Seventy-nine patients were males whereas thirty seven
patients were females giving a ration of2.l :1. All the 116 specimens were
processed, 87 (75%) were reported as positive for acute appendicitis and the rest 29
(25%) as normal vermiform appendix. The patients who had a score 0-4 points were 20
out of which 16 (13.7)% patients had normal appendicectomy and 4 (3.4%) had acute
1
appendicitis. Those who scored 5-6 points were 35 patients, and 27 (23.3%) had acute
appendicitis whereas 8 (6.8%) had normal appendicectomy. Those who scored 7-10
points were 61 patients, and 56 (48.3%) had acute appendicitis whereas 5 (4.3%) had
unnecessary appendicectomy. The overall negative appendicectomy rate (NA) was 25%,
of which 21.5% of the males and 32.5% ofthe females had normal appendix removed.
The modified Alvarado score adjusted NA rate was calculated to be 11.2%(P value of
0.000)
CONCLUSIONS
The study showed a male preponderance ratio of2.1 :1, with a peak age incidence
between 10-30 years. Twenty five percent of the appendicectomies were normal based on
clinical judgment of the senior house officers. When Modified Alvarado score was
applied in retrospect the negative appendicectomy rate reduced to 11.2% (p value of
0.000).
Citation
Master of Medicine (surgery), University Of Nairobi, 2005Publisher
University of Nairobi School of Medicine