Tailoring of computed tomography scanning in patients with acute appendicitis according to combined assessment by Alvarado score and focused ultrasound

Background: Deciding for appendectomy based only on the patient’s signs and symptoms results in negativeappendectomy in approimately 1/3 of cases. The rationale of this research is to decrease the negative appendectomy aswell as complicated appendicitis.Patients and Methods: This is a prospective study on 164 patients presented with acute appendicitis. We includedpatients of both sexes. Patients were assessed routinely using both the Alvarado score and focused ultrasound (US).Of the patients, 31 showed double positive of both Alvarado score and focused US and were considered as a controlgroup. Computed tomography (CT) scanning was applied to 133 patients who were not double positive. Sensitivities andspecificities of all tests were compared with histopathologic examination as a reference standard.Results: CT scanning accuracy in diagnosing acute appendicitis in comparison with pathology results is 100%. Caseswith +ve US and –ve Alvarado have an accuracy of 96.4% followed by cases with –ve US and +ve Alvarado, whichreaches 94.3% and the least is for double-negative cases (84.4%).Conclusion: The double-check test is a good cheap positive tool and could be used to diagnose true positive cases ofacute appendicitis with a sensitivity as that of CT scanning, while CT scanning could be preserved for the negative casesby the double-check test.