Comparison of clinical accuracy v/s investigations in the diagnosis of acute appendicitis

Subhash N. Halbhavi, Yamanur P. Lamni, B. V. Goudar, E. B. Kalburgi, Sushant P. T., Manjula R.


Background: Now a day there is a trend to rely more on high-tech investigations rather than taking thorough history and clinical examination of the patients in the diagnosis of acute pain abdomen. Commonest cause of acute abdomen in the surgical practice is appendicitis. Delay in the diagnosis and treatment of acute appendicitis, leads to complications. Objective of this study was to evaluate the accuracy of clinical diagnosis versus sensitivity and specificity of ultrasound examination and histopathological examination of the resected specimen of appendix. This study also assesses the incidence of negative appendectomies in a medical college hospital of North Karnataka.

Methods: This study included one hundred and fifty patients with history of pain abdomen where clinical diagnosis of acute appendicitis was made. The study period was of 18 months between February 2014 to July 2015. Routine blood investigations and abdominal ultrasonography were done in all cases. All ultrasound positive cases were subjected to surgery. Some ultrasound negative cases were also taken to surgery on the high suspicion of diagnosis of acute appendicitis depending upon thorough history taking and clinical examination. The diagnosis made depending on the ultrasound findings were compared with clinical findings, operative findings and histopathological examination reports.

Results: Out of 150 patients, 104 were male and 46 were female. The common symptoms were pain in the RIF (100%) and anorexia (80%).The overall sensitivity and specificity of clinical diagnosis was 96.9% and 90.48% respectively. The same for ultrasound was 86.99% and 33.33% respectively. The present study shows negative appendectomy rate 6.66% in females and 7.33% in males.

Conclusions: The diagnostic accuracy of ultrasound was 84.87% whereas clinical diagnosis was 96%. Thus, detailed history taking, and thorough clinical examination still holds good in the diagnosis of acute appendicitis and should be stressed in the clinical teaching.


Appendicitis, Appendectomy, Histopathological examination, Ultrasound

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Ellis BW. Acute appendicitis. In: Ellis BW, Brown SP. eds. Hamilton Bailey’s Emergency surgery 12th Ed. butterworth-Heinemann Ltd Oxford; 1995:411-423.

Liu CD, McFadden DW. Acute abdomen and appendix. Surgery: scientific principles and practice. 1997;2:1246-61.

Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910-25.

Schwartz S, Liver U, Schwartz S, Shires T, Spencer F. Principles of surgery, New York, McGraww-Hill; 1994:1307-18.

Wilcox RT, Traverso LW. Have the evaluation and treatment of acute appendicitis changed with new technology?. Surgical Clinics. 1997;77(6):1355-70.

Ramirez JM, Deus J. Practical score to aid decision making in doubtful cases of appendicitis. Br J Surg. 1994;81(5):680-3.

Lewis FR, Holcroft JW, Boey J, Dunphy JE. Appendicitis: a critical review of diagnosis and treatment in 1,000 cases. Arch Surg. 1975;110(5):677-84.

Hardin Jr DM. Acute appendicitis: review and update. Am family Physician. 1999;60(7):2027-34.

Kalan M, Talbot D, Cunliffe WJ, Rich AJ. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann Royal Coll Surgeons England. 1994;76(6):418.

George MJ, Siba PP, Charan PK, Rao RR. Evaluation of Ultrasonography as a useful Diagnostic Aid in Appendicitis. IJS Surg. 2002;64:436-9.

John H, Neff U, Kelemen M. Appendicitis diagnosis today: clinical and ultrasonic deductions. World J Surg. 1993;17(2):243-9.

Dey S, Mohanta PK, Baruah AK, Kharga B, Bhutia KL, Singh VK. Alvarado scoring in acute appendicitis- a clinicopathological correlation. Indian J Surg. 2010;72(4):290-3.