الفهرس 
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Abstract
Purpose: we aimed to determine the optimal indication for CT scan in patients presented with acute appendicitis according to a combined assessment by Alvarado score and focused ultrasound examination. Materials and methods : This is a prospective study on one hundred sixty-four patients presented with acute appendicitis. We included patients of both sexes. Patients were assessed routinely using both the Alvarado score and focused ultrasound. Thirty-one patients showed double positive of both Alvarado score and focused ultrasound and considered as a control group. CT scanning was applied to one hundred thirty-three patients who were not double positive. Sensitivities and specificities of all tests were compared to histopathologic examination as a reference standard. Results: CT scanning accuracy in diagnosing of acute appendicitis in comparison with pathology results is 100%. For cases with +ve US &-ve alverado have accuracy 96.4% followed by cases with -ve US& +ve alverado which reaches 94.3% and the least is for double negative cases (84.4%). Conclusions : The double-check test is a good cheap positive tool and could be used to diagnose true positive cases of acute appendicitis with a sensitivity as that of CT scanning, while CT scanning could be preserved for the negative cases by the double-check test.