Using modified Alvarado score in conservative treatment of acute appendicitis

Abstract

Background and objectives: Acute appendicitis is the most common and challenging surgical emergencies. The diagnosis is still based on the clinical examination. The modified alvarado score system isa safe diagnostic modality without extra expense and complications. Efficacy ofantibiotic treatment was often considered as a bridge to surgery inselectedpatients with acute appendicitis aided by using of Modified Alvarado scoring system. Methods: A prospective clinical trial comparing antibiotics with appendectomy, a total of 424 consecutive patients were enrolled, according to Modified Alvarado Scoring Systemwere divided into three groups: Group A: score between 8-10 (emergency surgery group),Group B: score between 5-7 (conservative group): these patients were subjected to repeated clinical examinations for 24 hours. Group C: scorebetween 1-4, the choice of antibiotic regimen was made by using an intravenous injection of (ceftriaxon 1g x2 and metronidazo l500mg x 3). Results: out of 424 patients, 206(48.6%) female and 218(51.4%) male. 156(36.8%) patients group A,148 (34.9%) group B, histopathology confirmed appendicitis in 128(82%). patients nine (5.8%) patient in group A revisiting hospital due to complications. Mean hospital stay in group A was lesser than group B. The antibiotic response rate was 91.3%, In group A 12(7.7%) patients had wound infection,while in group B and C seven (4.7%) had complications. Out Of 13 patients in the antibiotic group, nine (6%) underwent appendectomy during the initial hospitalization. Conclusions: Modified Alvaro Scoring System as a diagnostic tool,can be usedsafely for conservative treatment of patients with acute uncomplicated appendicitis by giving antibiotics only.