Diagnostic Efficacy Of Fenyo-Lindberg Scoring System In Patients Of Acute Appendicitis A One Year Cross Sectional Study At KLE Dr.Prabhakar Kore Hospital, Belgaum

Abstract

BACKGROUND AND OBJECTIVES -- Acute appendicitis is an acute inflammatory condition of appendix. Failure in early diagnosis of disease can result in progression and increased severity of disease. In developing countries like India, as early identification of the disease in the first instance is important as good number of people may be working away from home stations, in rural areas or in places where expert clinical advice is not available. These factors can result in missing the diagnosis, and the patient ends up in complications. As higher radiological investigations are costly, clinical examination findings remains the mainstay of diagnosis. Diagnostic scores have been found to be very easy and useful, and help in decision-making. The present study was taken up to calculate diagnostic efficacy of Fenyo-Lindberg scoring system in patients of acute appendicitis. MATERIALS AND METHODS – A one year cross sectional study was done between January 2018 and December 2018 in patients who had right lower quadrant pain. A total of 100 patients were taken. All the patients were scored according to the variables of scoring system and then divided them into two groups. Group I included patients with score of -2 and above (patients likely to have acute appendicitis) and Group II were patients with score below -2 (patients unlikely to have acute appendicitis).The diagnosis of acute appendicitis was confirmed by histopathological examination. The F-L score groups were cross-tabulated against histology, the gold standard. Then, the sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) and accuracy were calculated. RESULTS – The present study included 100 patients, the total number of males were 52 and females were 48. In 15 patients TLC was more than 14,000 whereas 16 patients had duration of onset of symptom less than 24 hours. 47 patients had vomiting. On clinical examination of the patients, tenderness at right lower quadrant was present in all cases, while rebound tenderness was present in 54% of cases. In 98% of the patients progression of pain was seen, whereas migration of pain was seen in 76% of patients and in 56% of patients there was increased sensation of pain on coughing. A total of 54 patients had Acute appendicitis on histopathology. The study shows that this scoring system has sensitivity of 72% and specificity of 71% in diagnosing acute appendicitis. The Positive predictive value was 75% and Negative predictive value was 68%. CONCLUSION – The Fenyo-Lindberg score is an inexpensive clinical tool that may help the diagnosis of acute appendicitis. The results are comparable to previous studies but as the sample size is small, study has to be done in higher sample size to get the data necessary to generalize the findings.