How much Reliable Is Alvarado Scoring System in Reducing Negative Appendectomy?

Abstract

There is still an ongoing debate, especially regarding early diagnosis of acute appendicitis. Early surgery leads to inadequate evaluation of acute abdominal pain and negative appendectomy, whereas delayed surgery leads to appendicitis perforation complications. The diagnosis of this condition is considerably difficult, especially due to subtle early symptoms and clinical condition. The aim of the present study was to identify whether the Alvarado scoring system could reduce the incidence of negative appendectomy in patients who will undergo surgery for acute appendicitis. Patients who underwent surgery with acute appendicitis prediagnosis were retrospectively classified as negative appendectomies (group A) and positive appendectomies (group B) according to histological diagnosis. All groups were evaluated for age, gender, Alvarado scores, and parameters. Two hundred eighty-one patients were included in the study. Group A contained 71 (25.3 %) patients, and group B contained 210 (74.7 %) patients. There was a significant difference in WBC, left shift, rebound, and change of pain localization between the groups ( = 0.002, < 0.001, < 0.001, and = 0.023, respectively). Alvarado scores were significantly different between the groups ( < 0.001). In logistic model examination, the major factor was the Alvarado score (7 or above) and the minor factor was spreading pain. The Alvarado scoring system can be used to reduce negative appendectomy in patients who will undergo surgery with acute appendicitis.

Value of Alvarado scoring system in diagnosis of acute appendicitis

“…Various scoring systems were designed to decrease the negative appendectomy rate and increase the positive diagnostic rate of appendicitis [ 10 ]. Among them, a comprehensive scoring developed by “ALVARADO” in 1986 provides a practical diagnostic aid in interpreting the diagnosis of acute appendicitis [ 8 ].…”

Incidence of negative appendicectomy: retrospective follow-up of histopathology specimens

“…14 The observation of 1,825 unusual pathologies in the retrospective review of 24,697 appendectomy specimens is in support of the continued use of routine histopathological examination of a resected appendix. 15,16 A systematic review of 19 studies on the usefulness of routine histopathological examination of appendectomy specimens also observed that the incidence of unexpected findings in appendectomy specimens is low and intraoperative diagnosis alone appears insufficient for identifying unexpected diseases and it is subject to great variation. 16,17 One of the limitations of this study was the inter-personal variation between surgeons diagnosing AA.…”

“…15,16 A systematic review of 19 studies on the usefulness of routine histopathological examination of appendectomy specimens also observed that the incidence of unexpected findings in appendectomy specimens is low and intraoperative diagnosis alone appears insufficient for identifying unexpected diseases and it is subject to great variation. 16,17 One of the limitations of this study was the inter-personal variation between surgeons diagnosing AA. Our study identified the overall negative appendicectomy cases done in Ibra referral hospital, but when we subdivided cases according to surgeons, the rate was higher for some surgeons and lower for others.…”

Is it beneficial to use clinical scoring systems for acute appendicitis in adults?

“…It can be possible to improve the diagnostic accuracy of AA and to help to select patients for immediate surgery, follow-up, or additive tests. [3,8,10,12,13] Two of the most widely used scoring systems since 1986 include Alvarado and modified Alvarado, both of which were developed in the West. [5] However, there were significant differences in sensitivity and specificity levels depending on the cut-off threshold levels and the geographic variation of the countries in which they were applied.…”

“…In previous studies, it has been shown that the sensitivity and specificity of the Alvarado scoring system vary with age, gender, and duration of symptoms. [13,[18][19][20] Therefore, there may be some modifications by adding or excluding some local parameters. The RIPASA scoring system has been one example that was developed for this purpose.…”