A prospective study for evaluation of Alvarado score in diagnosis of acute appendicitis

Navneetkumar M. Kapadia, Varin Rangwala, Jignesh B. Rathod, Ravi Bhatt, Sujan R. Patel


Background: Acute appendicitis is a common cause of abdominal pain for which a prompt diagnosis is rewarded by a decrease in morbidity and mortality. Delay in the diagnosis will lead to an increased morbidity and mortality rate, on another hand overzealous diagnosis may lead to increased negative appendectomy rates. Notwithstanding advances in modern radiographic imaging and diagnostic laboratory investigations, the diagnosis of appendicitis remains essentially clinical. To decrease the negative appendectomy rate and to increase the positive diagnostic rate of appendicitis, various scoring systems were designed. Alvarado score is one of them.

Methods: A total of 100 operated cases of appendicectomy were studied. Their clinical diagnosis, assessed by the Alvarado scoring is compared with radiological and histopathological diagnoses, to obtain the sensitivity and specificity of the Alvarado score system. NPV, PPV, and percentages of various demographic and clinical data were calculated accordingly.

Results: In this study, the positive predictive value of Alvarado scoring is found to be high i.e.; patients will have a high chance of acute appendicitis. On the other hand, the negative predictive value is low. Sensitivity for Alvarado's score is 50% while specificity is 88.9%.

Conclusions: In this study, we concluded that the Alvarado score has a very high positive predictive value i.e.; diagnostic accuracy. Also with the help of the Alvarado score, we can reduce the number of negative appendicectomies.



Alvarado score, Acute appendicitis, Positive predictive value

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Wray CJ, Kao LS, Millas SG, Tsao K, Ko TC. Acute appendicitis: controversies in diagnosis and management. Curr Probl Surg. 2013;50(2):54-86.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-64.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-64.

Bond GR, Tully SB, Chan LS, Bradley RL. Use of the MANTRELS score in childhood appendicitis: a prospective study of 187 children with abdominal pain. Ann Emerg Med. 1990;19(9):1014-8.

Hsiao KH, Lin LH, Chen DF. Application of the MANTRELS scoring system in the diagnosis of acute appendicitis in children. Acta Paediatr Taiwan. 2005;46(3):128-31.

Rezak A, Abbas HM, Ajemian MS, Dudrick SJ, Kwasnik EM. Decreased use of computed tomography with a modified clinical scoring system in diagnosis of pediatric acute appendicitis. Arch Surg. 2011;146(1):64-7.

Owen TD, Williams H, Stiff G, Jenkinson LR, Rees BI. Evaluation of the Alvarado score in acute appendicitis. J R Soc Med. 1992;85(2):87-8.

Saverio S, Podda M, Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020;15(1):27.

Frountzas M, Stergios K, Kopsini D, Schizas D, Kontzoglou K, Toutouzas K. Alvarado or RIPASA score for diagnosis of acute appendicitis? A meta-analysis of randomized trials. Int J Surg. 2018;56:307-14.

Macco S, Vrouenraets BC, Castro SM. Evaluation of scoring systems in predicting acute appendicitis in children. Surgery. 2016;160(6):1599-604.

Téoule P, Laffolie J, Rolle U, Reissfelder C. Acute Appendicitis in Childhood and Adulthood. Dtsch Arztebl Int. 2020;117(45):764-74.

Snyder MJ, Guthrie M, Cagle S. Acute Appendicitis: Efficient Diagnosis and Management. Am Fam Physician. 2018;98(1):25-33.

Bhangu A, Søreide K, DSaverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386(10000):1278-87.

Tekeli MT, Ilhan E, Ureyen O, Senlikci A, Yeldan E, Ozturk M, et al. How much Reliable Is Alvarado Scoring System in Reducing Negative Appendectomy? Indian J Surg. 2017;79(2):106-10.