Discriminant Classify Of The Pathologic Types Of Acute Appendicitis In Adults Through Modified Alvarado Scores And CT Imaging Signs

Objective:To study the relationship between the Modified Alvarado Scores, the CT imaging signs and pathological findings about acute appendicitis in adults. To evaluate identification appendicitis'pathological types through CT and Modified Alvarado Scores.Methods:452 patients with acute appendicitis (confirmed by surgery and pathology) were analysed retrospectively from June 2007 to July 2010. Case-control study was used to investigate the Modified Alvarado Scores (migratory RIQ(right lower quadrant) pain, anorexia/acetone, nausea/vomiting, tenderness RIF, rebound pain, elevated temperature, leucocytosis, and neutrophil>75%) and CT signs(appendiceal diameter dilatation, wall thickening, appendicolith, intraluminal fluid, intraluminal air, periappendiceal fat stranding, intraperitoneal fluid, extraluminal air, enlarged mesenteric lymph nodes, adjacent bowel wall thickening, and ileus) among different pathologic types. Statistically significant variables were used in discriminant classify of pathology and developed a Fisher discriminant function. Then we made retrospective and prospective assessment about the function.Results:18 of 35 factors including temperature, heart rates, respiratory rates, leucocyte count, neutrophile count, the proportion of neutrophile, fever, rebound pain, leucocytosis, increased the proportion of neutrophile, Modified Alvarado Scores points, intraluminal fluid, intraluminal air, periappendiceal fat stranding, intraperitoneal fluid, extraluminal air, enlarged mesenteric lymph nodes, adjacent bowel wall thickening, and ileus were statistically significant variables among different pathological types (p<0.05) and selected in discriminant analyse.6 factors including temperature, leucocyte count, the proportion of neutrophile, Modified Alvarado Scores points, periappendiceal fat stranding, and extraluminal air were useful in the discriminant function which accuracy was 76.52% in retrospective assessment and 77.78% in prospective assessment.Conclusion:The Modified Alvarado Scores and CT imaging signs were related to the pathology of appendicitis, and both of them are helpful to judge its pathological types, so they are useful to formulate reasonable therapeutic schedule and had important clinical value.