Evaluation of Alvarado score in diagnosing acute appendicitis

Abstract

Using a practical scoring system for diagnosing acute appendicitis can help reduce the rate of unnecessary surgery. This prospective study was carried out to evaluate Alvarado scoring system for diagnosing of acute appendicitis in our set up. Out of total 100 patients, appendicitis was confirmed in 80 patients, thus giving negative appendectomy rate of 20% (male 6%, female 14%). Perforation rate was 4%. Positive predictive value was 89%. The sensitivity was 54% and specificity 75%. Alvarado score is not a sensitive tool for aiding diagnosis of acute appendicitis.

Predictive values of Alvarado score, serum C-reactive protein, and white blood cell count in the diagnosis of acute appendicitis: a prospective study

“…The predictive values of Alvarado score in the current study are consistent with the results obtained by Pogorelic et al's sensitivity, specificity, PPV of 89%, 59%, 93.1%, and 46%, respectively [5]. Dey et al, as well as Nanjundaiah et al, Al Awayshih and associates in mixed population studies also observed comparable findings [4,11,18]. In this study, the decision to operate was based on the clinical judgement of the surgeon with a negative appendicectomy rate of 19% which was comparable to rates obtained in settings where CT scan is not routinely deployed in the diagnosis of acute appendicitis [11,13,14].…”

“…Dey et al, as well as Nanjundaiah et al, Al Awayshih and associates in mixed population studies also observed comparable findings [4,11,18]. In this study, the decision to operate was based on the clinical judgement of the surgeon with a negative appendicectomy rate of 19% which was comparable to rates obtained in settings where CT scan is not routinely deployed in the diagnosis of acute appendicitis [11,13,14]. The rate however drops to as low as 2.5-7.5% in settings where CT scan is routinely deployed [19,20].…”

“…The diagnosis of acute appendicitis still remains problematic due to unacceptably high negative appendicectomy rate in spite of the introduction of modern imaging techniques [11,15]. Though CT, ultrasound, and laparoscopy gave the best diagnostic accuracy in terms of high sensitivity and specificity, their use is fraught with many limitations: first, CT emits radiation that could lead to cancer in future; second, it is not costeffective in low-income countries in sub-Sahara Africa where most patients pay out of pockets; third, ultrasound on the other hand is dependent not only on the quality of the machine, but also on the operator, and inter-observer variation is a disadvantage [13,15,17].…”

“…A large number of scoring systems including Alvarado's score or its modification [7][8][9][10] have been developed to aid in the diagnosis with varying degrees of predictive values. Scoring systems are valuable and valid instruments of discrimination between acute appendicitis and non-specific abdominal pain [11]. The Alvarado score is the most well studied and best performing in validation studies, though it has some drawbacks [12].…”

A comparative study on the diagnostic validity of three scoring systems in the diagnosis of acute appendicitis in emergency centres

“…Therefore, given the low specificity of this parameter, normal range CRP cannot exclude acute appendicitis [ 19 ]. Considering these contradictory results and questioned diagnostic value of Alvarado system [ 20 , 21 ], the combination of Alvarado system and CRP (Alvarado + CRP) was assessed in our study. The sensitivity, specificity, PPV and NPV of the Alvarado + CRP system were 79%, 7%, 92%, and 20%, respectively.…”