Programme no. 429-OP
Patient Empowerment
Acute Appendicitis at Te Puna Hauara Clinic- A busy General Practice, Auckland, New Zealand
Hardeep Hundal*1
1GP,TE PUNA Hauora,AUCKALND,New Zealand
* = Presenting author
Objectives: To test if the Alvarado SCORING System is effective in the primary setting for patients with Right iliac fossa pain.
Background: Appendicitis is a very common acute surgical emergency. This condition is extremely difficult to diagnose at early stages. There are many differential diagnosis that mimic acute appendicitis. It also remains a burden to the Acute Surgical Team as they may be facing many referrals by primary health care providers what is actually not acute appendicitis. To aggravate the situation further, the cost of operating and discovering a normal appendix is high.

At the General Practice it is extremely challenging to refer or not to refer to the General Surgical team at the hospital. Differential diagnosis includes mesenteric adenitis, ovarian rupture, gastroenteritis, other Gastrointestinal and Gynaecological diseases.

Most common Symptoms of acute appendicitis are migratory RIF Pain, nausea and vomiting and anorexia. Most common SIGNS of appendicitis include right iliac fossa tenderness- McBurney’s tenderness, fever and rebound tenderness on the left iliac fossae. Lab investigations include leucocytosis and neutrophilic shift to the left.

Most common investigation at the GP setting is a urine dipstick test. This will rule out Urinary tract infections if there is a positive leucocyte. Other investigations included a blood test for a Full Blood count and a CRP.

Alvarado scoring system is a 10 point system used to diagnose acute appendicitis. It is often used by surgical and emergency medicine residents to diagnose acute appendicitis. This scoring system is safe and can be used in the General Practice setting.

Results: Alvarado Scoring system was a good scoring system when used in adults and paediatrics setting.

13 patients scored more or equivalent Alvarado score of six and were subsequently referred to hospital directly to the General Surgery/Paediatric General Surgery Department. 9 were males and 4 were females. All had their appendix removed and only 2 females had normal appendix.

45 patients scored an Alvarado score less than six. Only 9 patients were subsequently referred to hospital after two or three days.

Material/Methods: From August 2013 to August 2014, 58 patients with Right Iliac fossa were evaluated using the Alvarado scoring system. Patients scoring 6 or >6, were immediately referred to the Acute General Surgical Registrar. Almost all 100% patients were accepted by the General Surgery Department for further investigations + appendicectomy. Patients scoring less than 6 were advised to be monitored, watch and wait and referred to have their blood tested to check for Full Blood Count and CRPs. All 58 patients had to undergo a routine urine dipstick test.
Conclusion: ALVARADO SCORING is a sensitive and specific scoring system for appendicitis
Points for discussion: ANy scoring system should be adaptive to the local setting and scoring systems are very useful.