Use of Modified Alvarado Score in Diagnosis of Acute Appendicitis: A Prospective Study

Abstract

Acute appendicitis is one of the common causes of acute abdomen. The diagnosis of acute appendicitis is usually made on the basis of clinical features and confirmed by ultrasound examination and occasionally by Computerized tomography. This study was conducted to study the importance and diagnostic efficacy of Alvarado score in acute appendicitis and its effect on reducing negative appendectomies. Material and Methods: We conducted this prospective study comprising of 150 cases who were ill enough to warrant surgery for suspected appendicitis admitted to our institute scoring system described by Alvarado was adopted to reduce negative appendectomy. Patients were included in this study on the basis of a predefined inclusion and exclusion criteria Patients were either operated or managed conservatively on the basis of a combination of Alvarado score and clinical grounds. Surgery was done under general or spinal anesthesia. Data analysis was carried out using Minitab 17 version software. Results: Out of the 150 studied cases there were 90 (60%) males and 60 (40%) females with a M: F ratio of 1:0.66. Most common age group was found to be in between 21-30 yrs. Abdominal pain was predominant complaint which was present in all patients (100%) followed by anorexia (86%), nausea (84%) and constipation (16%). Most common site of pain was right iliac fossa (100%) and tenderness in RIF was present in 147 (98%) patients. Leukocytosis was seen in 85% cases. Modified Alvarado score was less than 5, 5-6 and more than 6 in 3, 21 and 126 patients respectively. Conclusion: The Modified Alvarado score is a useful diagnostic tool at a cutoff point of 7 for all patient groups. Modified Alvarado score (7 or more) has a high sensitivity and positive predictive value for the diagnosis of appendicitis and hence can be routinely used in all district general hospitals with basic lab facilities and particularly where facilities of USG Scan or CT scan are not available.

Unveiling the Role of Inflammatory Mediators and Gut Microbiome in Appendicitis: Types and Applications in Clinical Scoring

“…A cutoff score of 7 or higher is often used to indicate the need for appendectomy. The RIPASA score has been shown to have higher sensitivity and specificity compared to other commonly used scoring systems such as the Alvarado score [83].…”