Modified Alvarado Scoring System as a diagnostic tool for Acute Appendicitis at Bugando Medical Centre, Mwanza, Tanzania

Abstract

BackgroundDecision-making in patients with acute appendicitis poses a diagnostic challenge worldwide, despite much advancement in abdominal surgery. The Modified Alvarado Scoring System (MASS) has been reported to be a cheap and quick diagnostic tool in patients with acute appendicitis. However, differences in diagnostic accuracy have been observed if the scores were applied to various populations and clinical settings. The purpose of this study was to evaluate the diagnostic value of Modified Alvarado Scoring System in patients with acute appendicitis in our setting.MethodsA cross-sectional study involving all patients suspected to have acute appendicitis at Bugando Medical Centre over a six-month period between November 2008 and April 2009 was conducted. All patients who met the inclusion criteria were consecutively enrolled in the study. They were evaluated on admission using the MASS to determine whether they had acute appendicitis or not. All patients underwent appendicectomy according to the hospital protocol. The decision to operate was the prerogative of the surgeon or surgical resident based on overall clinical judgment and not the MASS. The diagnosis was confirmed by histopathological examination. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software.ResultsA total number of 127 patients were studied. Their ages ranged from eight to 76 years (mean 29.64 ± 12.97). There were 37 (29.1%) males and 90 (70.9%) females (M: F = 1:2.4). All patients in this study underwent appendicectomy. The perforation rate was 9.4%. Histopathological examination confirmed appendicitis in 85 patients (66.9%) and the remaining 42 patients had normal appendix giving a negative appendicectomy rate of 33.1% (26.8% for males and 38.3% for females). The sensitivity and specificity of MASS in this study were 94.1% (males 95.8% and females 88.3%) and 90.4% (males 92.9% and females 89.7%) respectively. The Positive Predictive Value and Negative Predictive Value were 95.2% (males 95.5% and females 90.6%) and 88.4% (males 89.3% and females 80.1%) respectively. The accuracy of MASS was 92.9% (males 91.5% and females 87.6%).ConclusionThe study shows that use of MASS in patients suspected to have acute appendicitis provides a high degree of diagnostic accuracy and can be employed at Bugando Medical Centre to improve the diagnostic accuracy of acute appendicitis and subsequently reduces negative appendicectomy and complication rates. However, additional investigations may be required to confirm the diagnosis in case of atypical presentation.

Clinico sonological and laboratory co-relation with histopathology of acute appendicitis to develop new diagnostic scoring system (Yash scoring system)

“…Over the last two decades different protocols have been introduced and tested by different researchers which include Lidverg, Fenyo, Christian, Ohman and Alvarado scoring system to make an early diagnosis of this sometimes very elusive disease. [24][25][26][27][28][29][30][31][32][33][34] In the present study found 13 (3.11%) cases of perforated appendix. The study done by S Salati, A Rather, and S Wani in kashmir shows higher rate of perforation.…”

“…35 If we compare it with previous studies in other scoring systems, results of present study were much higher ( Table 9). [25][26][27][28][29][30][31][32] Histopathology is considered as a gold standard for diagnosis of acute appendicitis. In a present study (6.69%) patients were have normal on histopathological examination.…”

The appendicitis scores may be useful in reducing the costs of treatment for right lower quadrant pain

“…[35] Having used a modified Alvarado score, Kanumba et al [36] found sensitivity, specificity, and diagnostic accuracy rates to be different for men and women (95.8%, 92.9%, and 91.5% versus 88.3%, 89.7% and 87.6%, respectively). In the Lintula scoring system, however, the sex of the patient is considered a separate parameter.…”

The predictive value of Alvarado score, inflammatory parameters and ultrasound imaging in the diagnosis of acute appendicitis

“…However, a scoring system that is cost effective, repeatable, and can be applied quickly in the preoperative period is quite important in the AA diagnosis algorithm especially for young residents and emergency physicians working in rural areas (9,10).…”