Comparative Evaluation of the Clinical and Paraclinical Diagnosis in Patients with Acute Appendicitis

Aims: Acute appendicitis is the most common emergency surgery; thus, its diagnosis requires high accuracy. This study aimed to determine the agreement between clinical and paraclinical diagnoses in patients with acute appendicitis. Instrument Methods: This descriptive study was performed on patients referred to Shahid Beheshti Hospital in Yasouj with suspicion of acute appendicitis in 2018. After considering the inclusion criteria, the files of 200 patients were included in the study by purposive sampling. Age, sex, main problem, symptoms, clinical signs, white blood cell count, and ultrasonography and pathology report were extracted from the patients’ files, and the Modified Alvarado Score was calculated based on their information. Findings: The mean age of the patients was 24.3±13.2 years, and the most common symptoms were anorexia and abdominal tenderness. The Modified Alvarado Score was  4-6 in 126 (63%) and 7 or higher (37%) in 74 patients. In addition, 182 patients (91%) had a positive pathology for appendicitis. There was a statistically significant relationship (p=0.03) between Modified Alvarado Score and pathology; however, there was no statistically significant relationship (p=0.43) between Modified Alvarado Score and ultrasonography. There was a significant relationship (p=0.0001) between pathology and ultrasonography. The ultrasonography sensitivity was 37.1%, specificity was 87.2%, positive predictive value was 96.8%, and negative predictive value was 11.7%. Conclusion: There is an agreement between the Modified Alvarado Score and ultrasonography in diagnosing acute appendicitis with the pathology as the gold standard in the diagnosis of appendicitis; however, there is no agreement between the Modified Alvarado Score and ultrasonography.