A Hospital Based Prospective Study to Assess the Clinical and Laboratory Parameters in Diagnosing Patients with Acute Appendicitis Admitted in Surgical Ward

Abstract

Background: Acute appendicitis is one of the most common general surgical emergency that has a lifetime risk of about 7%. The laboratory investigations namely white blood cell count (WBC), C-reactive protein (CRP) and erythrocyte blood sedimentation rate (ESR) are useful in diagnosing acute appendicitis. This study proposes to compare the various scoring systems in diagnosing a case of acute appendicitis and to suggest a scoring system which is suitable for our population. Materials & Methods: A hospital based prospective study is to be conducted on 50 patients admitted in department of general surgery at district hospital for appendicectomy during one year period. Informed consent will be taken from each respondent. The per-operative macroscopic appearance of the appendix specimen and subsequent histo-pathological study of the specimen is to be performed. Chi-square tests, Student's t tests, significance testing, and 95% Confidence Interval formulation are to be carried out wherever appropriate.Results: Acute appendicitis was more common in age group less than with more than 90.62% of patients with appendicitis being less than 40 years of age and is statistically significant (p value < 0.05*). The occurrence of acute appendicitis was significantly higher when the duration of symptoms was less than 2 days. This p value is statistically significant (p value < 0.05*). When the C reactive protein levels were higher than 10 mg/dl, the occurrence of acute appendicitis was significantly higher than in the patients with levels less than 10 mg /dl. The occurrence of acute appendicitis did not have any significant correlation with the serum bilirubin levels when the cut off was placed at 2 mg/dl in this study (p value = 0.243). When the ESR levels were higher than 15 mm/hr, the occurrence of acute appendicitis was significantly higher than in the patients with levels less than 10 mg /dl. The p value is < 0.05*.The various scoring systems analyzed were compared among themselves and along with the combined predictor score formulated. Conclusion: We concluded that there must be early and prompt diagnosis, adequate resuscitation as well as early surgery in patients with acute appendicitis to keep the morbidity and mortality low. In patients with equivocal findings, imaging studies and laboratory tests should be ordered to help confirm the diagnosis.