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Research Paper | General Surgery | India | Volume 11 Issue 11, November 2022
Triple Assessment of Acute Appendicitis: A Better Diagnostic Modality
Pradhay Sreeramulu | Dr. Vedanth M  | Dr. Sreeramulu P N
Abstract: Introduction: Acute appendicitis is one of the most common surgical emergencies and the most common source of infection in community-acquired intra-abdominal infections. Its diagnosis is usually made depending on the presenting history, clinical evaluation, and physical examination. It is further reinforced by laboratory investigations, such as white blood cells, differential counts (the percentage of neutrophil granulocytes and band neutrophil granulocytes) and C-reactive protein (CRP). Aims and Objectives: To compare the efficacy of clinical impression, biochemical markers (CRP, NLR, TLC) C-reactive protein, and radiological imaging with HPR in the diagnosis of Acute Appendicitis. Results: In the study among 91 subjects with appendicitis by HPE, 75.8% were diagnosed by Biochemistry, 85.7% were diagnosed by Radiology, 68.1% were diagnosed by Clinical and 85.7% were diagnosed by Combined methods. Among 9 subjects without Appendicitis by HPE, 100% were diagnosed as negative by biochemistry, 88.9% were diagnosed as negative by Radiology, 100% were diagnosed as negative by Clinical, 11.1% were diagnosed as negative by combined methods. Combined methods had sensitivity of 85.71%, specificity of 88.89%, PPV of 98.73%, NPV of 38.1% and Diagnostic Accuracy of 86%. Agreement of combined methods with HPE Diagnosis was 0.4661 [Moderate agreement]. Conclusion: The diagnosis of appendicitis in this study showed us No single clinical or laboratory test is able to reliably predict acute appendicitis. USG of the abdomen had an important role in the diagnosis of appendicitis with significant sensitivity, specificity, and PPV. Use of triple assessment for acute appendicitis using laboratory investigations and USG imaging as an adjunct to clinical diagnosis will help to diagnose acute appendicitis in patients with RIF pain.
Keywords: Acute Appendicitis, Triple assessment, Biochemistry, Radiology
Edition: Volume 11 Issue 11, November 2022,
Pages: 353 - 360