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Category: Volume 06 Issue 08 August 2018
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Title: PASTER Score: Decision Making in Acute Appendicitis Made Easy

Authors: Dr Sumesh Kaistha, Dr K Shankar Reddy

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i8.78

Abstract

Introduction: Acute appendicitis is the most frequent surgical emergency encountered worldwide and diagnosing it may be difficult at times and therefore many scoring systems have been devised. However, most of them include many clinical and laboratory variables, making them impractical to be applied at field areas. We devised a pure bedside novel scoring system: PASTER score, to overcome these limitations.

Objective: To frame a completely clinical scoring system independent of any lab values/imaging modality, which could aid in the diagnosis of acute appendicitis amongst the military population and compare it with time tested Alvarado scoring system. This study was to compare the efficacy of PASTER score with Alvarado score in the diagnosis of acute appendicitis.

Materials and Methods: An observational prospective study was conducted between Jan 2014 to Aug 2016 on 155 patients who were diagnosed as Acute Appendicitis and had undergone emergency appendicectomy based on clinical judgement. PASTER and Alvarado score were calculated in all these patients at the time of admission. The histopathology diagnosis was used as the gold standard against which diagnostic performance of Alvarado score and PASTER score were compared.

Results: The complete data of 155 serving soldiers was analyzed at the end of the study period. The mean age was 27.73 ± 9.46 years. A negative appendectomy rate of 7.1% was observed during the study. The diagnostic performance of PASTER score was superior to that of Alvarado score with sensitivity, specificity and diagnostic accuracy of 95.14% versus 86.11%, 63.64 versus 27.27%, and 93% versus 82%respectively (p-value < 0.001).

Conclusion: PASTER score is a very simple, fast and an effective modality to establish the diagnosis of acute appendicitis with a very high accuracy thus reducing delay in diagnosis and unnecessary referrals to higher centers and therefore, it is very relevant in armed forces setup. Its relevance in general public remains to be studied.

Keywords: Appendicitis, Alvarado score, PASTER score, Appendicectomy.

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Corresponding Author

Dr K Shankar Reddy MBBS, MS

Graded Specialist Surgery, Command Hospital Air Force, Agaram (Post), Bengaluru – 560007, India

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