DIAGNOSTIC ACCURACY OF CLINICAL EXAMINATION VERSUS COMBINATION OF ABDOMINAL ULTRASOUND AND ALVARADO SCORE, IN PATIENTS WITH ACUTE APPENDICITIS

Objective: To compare the diagnostic accuracy of clinical examination with that of a diagnostic protocol consisting of ultrasound and Alvarado score in patients with acute appendicitis.Material and Methods: A study comparing clinical diagnosis (control group) with a diagnostic protocol incorporating Ultrasound and Alvarado score (intervention group) was conducted in surgical A ward Lady Reading Hospital from February 2004 to March 2006. Total of 308 patients with suspected acute appendicitis were considered for the study. 158 patients were randomized to control group and 150 patients to intervention group. Alvarado scoring system assessed all of 150 patient of the intervention group and 130 of these patients underwent ultrasound. The main out come measured were, time to operation, hospital stay, any adverse out come, negative appendicectomy and delayed operation leading to perforation.Results: Sensitivity and specificity of ultrasound and Alvarado scoring system were 97.91% and 75%, respectively. Patient in intervention group who underwent therapeutic operation had a significantly shorter mean time to operation than the patients in the control group (6.9 Vs 10.1 hours).There were no difference between groups in mean duration of hospital stay (61.3 Vs 62.5 hours), proportion of patients undergoing non therapeutic operations (1.33% Vs 4.33%) or delayed treatment in association with perforation of the appendix (3.33% Vs 11.9%).Conclusion: Ultrasound and the Alvarado scoring system is a diagnostic tool that leads to an early diagnosis and rapid surgical treatment of acute appendicitis. However it does not prevent complications or reduce the length of hospital stay.