Modified Clinical Score of Acute Appendicitis


background Suspected acute appendicitis is the most common non traumaticadmissions to the surgical emergency units .Over past 100 years mortality andmorbidity rates related to appendicitis have markedly decreased. The diagnosis ofacute appendicitis is predominantly a clinical preoperatively but final diagnosis of acuteappendicitis needs surgical reports per-operatively and the standard pathologicalexaminations postoperatively .There are many clinical scores have been established to help inthe diagnosis of the condition in surgical emergency room by junior surgeons in a short timein order to perform surgery in solid bases The main purposes of accurate diagnosis of acuteappendicitis :-1-Management of acute appendicitis in a short time and high accuracy to:-A-Avoid delayed diagnosis and prevent complications like perforation and finally peritonitisso mortality and morbidity of appendicitis markedly decreaseB-Avoid missing of any cases .2 -Avoid unnecessary surgery. Alvarado scoring system especially for junior residents whowork as the primary receptors of surgical cases at surgical emergency units. Alvarado scoresystem was identified as a useful clinical tool because it is readily available , extremelyaffordable ,and relatively accurateAims This study: was conducted to modify Alvarado scoring system to more easyapplicable, simple, cheap, quick and test( Reliability of suggested scoring system ) by whichwe avoided laboratory readings and technical errors that may cause diagnosticdifficulties Patients and Methods a prospective study of 120 patients with suspected acuteappendicitis admitted to surgical department -Al-Hussein teaching hospital—Karbala duringthe period from 1st January—to 31st December 2010 were included in this study. Thepatients were given specific scores according to this (Suggested score system) categorizedinto three categoriesCategory 1 patients score 7 or more who underwent surgeryCategory 2 patients score 5—6 admitted for a surgical ward under observation Category 3patients score 4 or less where acute appendicitis can be excluded. All appendices thatremoved surgically were sent for histopathological examination.Results By the (Suggested Score) Out of 120 patients 80 patients underwentsurgery and acute appendicitis were confirmed in 60 patients thus negative appendectomythus giving negative appendectomy frequency of 20%. Perforation rate was 6.25%.PositivePredictive Value was 80% (male 84% female 76%)Conclusion The (suggested scoring system) aids in the diagnosis of acute appendicitis. Ithelps junior residents in early diagnosis of acute appendicitis. It is quicker—simpler cheaperand easily applicable than Alvarado score in Iraq. The (Reliability of suggested scoringsystem) tested in this study and the result was that the new score had a good reliabilitycompared to Alvarado scoring system