Diagnosis of Acute Appendicitis Using Scoring System: Compared with the Alvarado Score

Abstract

Purpose: This study evaluated the usefulness of a new scoring system in diagnosing acute appendicitis which expresses the patient's symptoms, physical examination, and laboratory findings more clearly and objectively. Methods: A prospective study was conducted with 314 patients who were hospitalized with suspicion of acute appendicitis. After analyzing the symptoms, physical examination, and laboratory findings, 10 meaningful variables were selected, each of which were scored separately. The diagnostic value of the new scoring system was evaluated, and analyzed in comparison to the preexisting Alvarado score. Results: Ten variables including vomiting, migration pain, fever, Dunphy's sign, Rovsing's sign, tenderness, rebound tenderness, increased white blood cell counts, increased neutrophil proportion, and increased CRP levels were associated with acute appendicitis. The new scoring system is developed by applying 1 point for each variable, with a total score of 10 points. In the new scoring system, a score above 5 points had sensitivity of 0.75, specificity of 0.73, positive predictive value of 0.92, and diagnostic accuracy of 0.71. The area under the receiver operating characteristic curve was 0.80, which is larger than 0.72 of the preexisting Alvarado score, and thus has a higher diagnostic accuracy. As acute appendicitis progresses, the average score tends to become significantly higher (P=0.001). Conclusion:The new scoring system, which objectively reflects the clinical variables of the patient's symptoms, physical examination and laboratory findings, will be useful in accurately diagnosing acute appendicitis and in quickly deciding a therapeutic policy in patients with right lower abdominal pain. (J Korean Surg Soc 2010;79:207-214)

Comparison of acute inflammatory score and Alvarado score in diagnosis of acute appendicitis at a tertiary care hospital

“…The same was validated in many studies prior by Sudhir et al and Kim BS et al in their studies. 10,11 Few of the studies which used Alvarado scoring system did not include C reactive protein in the study group and found no difference in the rates of perforated appendix, negative appendectomies and complications between the groups. They also found a delayed appendectomy rate (2 vs 8%) and a lower delayed discharge rate (11 vs 22%) in the group.…”

Alvarado score: can it reduce unnecessary CT scans for evaluation of acute appendicitis?

“…The composite Alvarado scores are categorized as low (0-3), equivocal (4-6), or high (7-10) probability for acute appendicitis. Historically, the Alvarado metric favors specificity over sensitivity, with high positive predictive value (PPV) and diagnostic accuracy for acute appendicitis [18,19].…”

Evaluation of appendicitis inflammatory response score in suspected cases of acute appendicitis

“…The present study shows that AIR Score has a good statistical discriminating property for diagnosing acute appendicitis with a high sensitivity (78.57%) and specificity (85.71%) when the cut off for diagnosing acute appendicitis was kept at or less than 8 which was similar to other studies done by Frank c, Yang Q etal [14] . When the cut off for diagnosing acute appendicitis by AIR Score was kept at or more than 8 it had a sensitivity of 44% and a high specificity 100% and at this cut off score AIR Scoring cannot be used as a modality to screen patients with acute pain abdomen in Rt Iliac fossa as it is diagnostic of acute appendicitis at a score of 8 and above [15] .…”