Modified alvarado score in diagnosis of acute appendicitis: a clinicopathological study

Abstract

Background: Acute appendicitis is one of the commonest surgical emergencies in all ages. Diagnosis is mainly clinical, delay in diagnosis definitely increases the morbidity, mortality and cost of treatment, more aggressive surgical approach has resulted in increased white appendectomies. Methods: A total 100 cases hospitalized with abdominal pain, suggestive of acute appendicitis on the basis of modified Alvarado scoring system and were subsequently operated, were included in the present study in our institute for period of 20 Months. Results: Males belonging to young age group of 21-30 were most commonly affected. Abdominal pain was seen in 100% of patients. Fever seen in 87% of patients and vomiting in78%. Modified Alvarado score of 9 had positive predictive value of 100% while negative predictive value 8.9%, while score between 7-8 had positive predictive value of 98.9% and negative predictive value 27.8%. The sensitivity was 86.1% and specificity was 83.3%. The ultrasonography showed a sensitivity of 94.68%. In present study rate of total white appendectomy was 6%. The Modified Alvarado scoring system is a reliable and practicable diagnostic modality to increase the accuracy in diagnosis of acute appendicitis and thus to minimise unnecessary appendectomy. Conclusions: Young males are most commonly affected almost always presents with abdominal pain. The Modified Alvarado scoring system is a reliable and practicable diagnostic modality to increase the accuracy in diagnosis of acute appendicitis and thus to minimise unnecessary appendectomy.

Evaluation of modified Alvarado scoring system in diagnosis of acute appendicitis - a prospective study

“…In the current study, the PPV was 87.5% at a score of at least 7, which is comparable with the previous results. 6,7 In the current study, at the cutoff point modified Alvarado score of at least 7; the sensitivity was 93.33%, which is comparable with the results of Muzaffaruddin and Amer in their respective studies. Another study conducted by Pruekprasert et al, reported sensitivity of 79% at a score of at least 7.…”

Evaluation of Alvarado score in diagnosing acute appendicitis

“…The sensitivity in this study was 54% which is similar to that reported by Al Hashemy and Seleem [6] and lower than that reported by Lone et al of 88% [8]. The positive predicative value 90% in this study is close to that of other studies [9,10]. Our study shows that Alvarado scoring system is not sensitive enough to be helpful in the diagnosis of acute appendicitis.…”

Clinical Relevance of Modified Alvarado Score in Acute Appendicitis in Present Scenario

“…This finding correlated well with other studies in literature. 6,2,8 In our study the most common symptom in the patients was migratory pain i.e. 92% of the patients.…”

“…In all the studies reviewed, the sensitivity of MAS was always found lower in the female group. 6,2,8,10,14 We also reviewed the results already published about the old Alvarado score containing 10 points instead of 9 points of MAS. We found that, the sensitivity of both the scores was quite comparable.…”

“…1 Appendicitis, though was described way back in 1886, by Reginald Heber Fitz but even after so many years it is still considered a diagnostic challenge for treating surgeons. 2 Clinical examination, when used alone, can lead to negative appendectomy rate (NAR) of 15-30% and this rate is even higher in the females of reproductive age group i.e. 15-50%.…”