EVALUATION OF MODIFIED ALVARADO SCORE FOR FREQUENCY OF NEGATIVE APPENDICECTOMIES
AbstractBackground: Appendicitis being the commonest surgical emergency is primarily diagnosed clinicallybut posses diagnostic difficulty usually, especially to junior surgeons, demanding the need fortool/scoring system that can be easily applicable, accurate & reproducible in the diagnosis ofappendicitis, with low negative Appendicectomy rate. This study is designed to assess one such scoringsystem, i.e., Modified Alvarado Score. Methods: A total of 100 consecutive male and female patientswith age 10 year and above presenting with symptoms suggestive of acute appendicitis were includedin study, assessed according to eight variables of Modified Alvarado scoring system and wereaccordingly placed into 3 groups. Group–I patients having score 1–4 were discharged, Group-II patientshaving score 5–7 were observed while Group-III patients having score 8–10 were operated. Status ofappendix of operated patients was assessed histo-pathologically. Results: Out of 100 patients includedin study, 58 patients were operated on the basis of said scoring system. Of the operated patients 52(89.65%) had acute appendicitis, thus yielding a positive predictive value of 89.66% while negativeappendectomy rate of 10.34%. Frequency of negative appendicectomy was 7.69% (3/39) amongstmales and 15.79% (3/19) in females. Post-operative complication rate including wound infection,pelvic abscess, chest and urinary tract infection was 22.41% (13/58). Conclusion: Frequency of thenegative appendicectomies can be reduced through standardization of the diagnostic procedure, byapplying Modified Alvarado score in the diagnosis of suspected appendicitis cases as compared tosimple clinical assessment.Keywords: Appendicitis, Modified Alvarado Score, frequency, appendicectomy
Salari AA, Binesh F. Diagnostic value of anorexia in acute
appendicitis. Pak J Med Sci 2007;23(1): 68–70.
Khan I, Rehman A. Application of Alvarado scoring system
in diagnosis of acute appendicitis. J Ayub Med Coll
Abbottabad 2005;17(3):41– 4.
Sooriakumaran P, Lovell D, Brown R. A comparison of
clinical judgment vs the modified Alvarado score in acute
appendicitis. Int J Surg 2005;3:49–52.
Gulzar S, Umar S, Dar GM, Rasheed R. Acute appendicitis–
importance of clinical examination in making a confident
diagnosis. Pak J Med Sci 2005;21(2):125–32.
Al-Hashemy AM, Seleem MI. Appraisal of the modified
Alvarado Score for acute appendicitis in adults. Saudi Med J
Khan MN, Davie E, Irshad K. The role of white cell count
and C-reactive protein in the diagnosis of acute appendicitis.
J Ayub Med Coll Abbottabad 2004;16(3):17–9.
Shah SH, Rashid M. Appendicectomy; modified Alvarado
scoring system; does it help to avoid unwanted operation?
Professional Med J Mar 2004;11(1):68–71.
Al-Fallouji M. Postgraduate Surgery. The Candidate Guide.
nd edtion. UK: Butterworth Heinemann; 1998:p. 388–9.
Horzić M, Salamon A, Kopljar M, Skupnjak M, Cupurdija K,
Vanjak D. Analysis of scores in diagnosis of acute
appendicitis in women. Coll Antropol 2005;29:133–8.
Ijaz A, Riaz I, Hassan H, Hanif M, Shahzad K, Akhtar I,
Khan MM. Scoring System for the Diagnosis of Acute
Appendicitis. Pak J Surg 2000;16(3):37–40.
Wulff HR. Rational diagnosis and treatment. Oxford:
Blackwell Seientific; 1976.
Sava G, Bouchet P, Marescaux J, Grenier JF. La mortalite
del’ appendicectomie. A propos d’une serie homogene de
cas. Ann Chir 1981;35:21–6.
Hoffmann LO, Rasmussen O. Aids in the diagnosis of acute
appendicitis. Br J Surg 1989;76:774–9.
J Ayub Med Coll Abbottabad 2010;22(4)
Hay JM. Appendicite. Revue du Praticien (Paris)
Wazir MA, Anwar AR, Zarin M, Acute appendicitis, a
reterospective study. J Postgrad Med Inst 1998;12:33–6.
Arain GM, Sohu KM, Ahmed E, Haider W, Naqi SA. Role of
Alverado score in diagnosis of acute appendicitis. Pak J Surg
Walker SJ, West CR, Colmer MR. Acute appendicitis: does
removal of a normal appendix matter. What is the value of
diagnostic accuracy and is surgical delay important? Ann R
Coll Surg Engl 1995;77:358–63.
Ohmann C, Yang Z, Franke C. Diannostic scores in Acute
Appendicitis. Abdominal pain Study group. Eur J Surg
Fenyo G, Lindberg G, Blind P, Enochsson L, Oberg A.
Diagnostic decision support in suspected acute appendicitis:
validation of a simplified scoring system. Eur J Surg
Alverez SAJ, Fernandez R, Matin LJ, Gil JM, Moreno AM.
Diagnostic validity of signs and symptoms defining the
diagnosis of acute appendicitis. Gastroenterol Heptol