Comparision of Modified Alvarado score and Teicher score in predicting acute Appendicitis: A Prospective Study

medicine

Introduction: Acute Appendicitis is the most common surgical emergency encountered by the General Surgeon. It continues to be a clinical dilemma, despite the addition of myriad diagnostic modalities to the surgeon’s arsenal. A reliable scoring system would help streamline diagnosis as well as avoid unnecessary surgeries, in a limited resource setting. Materials and Methods: A prospective, observational hospital-based study was conducted in patients presenting in Bir Hospital ER with features suggestive of acute appendicitis. Sample size was 100. History and clinical examination, related laboratory investigations were collected and Modified Alvarado score and Teicher score were calculated. These scores were compared to Histopathology report and with regards to Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and Diagnostic accuracy using SPSS version 20. Result: 100 patients were enrolled with mean age of 30 years. Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and Accuracy for Modified Alvarado Score and Teicher Score respectively were 73.91% vs. 69.57%, 75% vs. 75%, 97.14% vs. 96.97%, 20% vs. 17.65% and 74% vs. 70%. Negative Appendectomy Rate was 8%. Area under curve for ROC of MAS was 0.761 with p-value of 0.015 which was significant statistically. Area under curve for ROC of Teicher Score was 0.747 with p-value of 0.021 which was also statistically significant. Conclusions: Both MAS and Teicher scoring systems can be of value in decision making in acute appendicitis and in reducing the number of negative laparotomies. However, MAS is better scoring system compared to Teicher score in diagnosis of acute appendicitis.

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