Validation of Anderson Score for Diagnosis of Acute Appendicitis by Histopathology: A Prospective Observational Study

Background: Appendicectomy is a very common operation performed. Because of advances in ultrasonography and CT Scanning, there is improvement in the diagnosis of appendicitis, but still, clinical observation and experience of the surgeon matters a lot. Removing normal appendix leads to multiphasic problems. Furthermore, appendix has proved to be a useful structure in reconstructive surgeries.

Aim: This study evaluates the validation of the Anderson score for diagnosis of acute appendicitis by histopathology.

Methods: This prospective observational study was performed in the Surgery Department at SGT Medical College, Gurugram, Haryana. The study included a total of 100 patients. Informed consent was taken for examination and investigations giving due respect to maintain the patient’s privacy and keep them comfortable. A detailed history was taken, clinical examination and investigations were done. All patients were subjected to Anderson's score. Appendix was sent for Histopathology examination. Sensitivity, specificity, positive predictive value and negative predictive values were found out. Statistical analysis was carried out using statistical SPSS version 23 software by using the Chi-square test.

Results: In 70 patients, Anderson score was >8, which was in favor of acute appendicitis. It means these patients should require surgery. In 30 patients score was <8. The sensitivity, specificity, positive predictive value and overall accuracy of clinical examination have been found to be 63.2%, 81.8%, 62.2% and 70.8% respectively. The most common histopathology finding was acute appendicitis then diffuse suppurative appendicitis followed by gangrenous appendicitis still followed by diffuse suppurative appendicitis with peri appendicitis.

Conclusions: The study found out that if Anderson's score is
8, appendicectomy should be done. But if Anderson's score is 0-4, the patient should be managed conservatively, if the score is 5-8, the final decision will depend on further investigations, observations and a second opinion.