Combined Use of Modified Alvarado Score and Focused Appendicitis Ultrasonography in Predicting Acute Appendicitis in Children: How to Reduce the Need for Unnecessary Ct Scans

 Acute appendicitis is one of the most common abdominal emergencies worldwide. The Modified Alvarado score is 9-point scoring system for diagnosis of appendicitis based on clinical signs and symptoms and differential leucocyte count. Previous studies have suggested that Alvarado score alone is inadequate as a diagnostic test, but it has been advocated as a means of select ing patients who should undergo imaging.To evaluate the effectiveness of Modified Alvarado Score and Focused Appendicitis Ultrasonography in predicting acute appendicitis and to compare the accuracy of two modalities alone and combined.

The study was performed in the postgraduate department of General Surgery, Government Medical College, Jammu over a period of one year from November 2021 to October 2022. 100 patients who were under the age of 18 years irrespective of their gender suspected to have appendicitis were included in the study.

 There were 64 males and 36 females. The majority of patients were in the age group of 12-15 years (51%). Modified Alvarado Score alone has sensitivity of 84.51%, specificity of 33.33%, Positive predictive value of 83.53%, negative predictive value of 34.98% and accuracy of 74.27%. Focused ultrasonography alone has sensitivity of 100% and accuracy of 80.00%, positive predictive value of 80%. The combined sensitivity of MAS+ focused appendicitis ultrasonography is 98.80 % with specificity of 11.76%, positive predictive value of 81.75%, negative predictive value of 70.94% and accuracy of 81.39%. The percentage of negative appendectomies was 14.45%.

  The sensitivity of Modified Alvarado Score is less than the sensitivity of Focused Appendicitis Ultrasonography. When both investigations combined together, their sensitivity, specificity, positive value, negative predictive value and the accuracy improves the diagnosis of acute appendicitis.