Application of alvarado scoring system in diagnosis of acute appendicitis

Appendicitis is an important differential diagnosis in patients with right iliac fossa pain. Acute appendicitis is one of the most common surgical emergencies with a life time prevalence of approximately 1 in 7[2]. To analyze the Alvarado score in relation to the diagnosis and management of acute appendicitis. This study was carried out in Surgical Unit III, Nishtar Medical College/hospital Multan. The study period was from January 2003 to December 2005. Sample size consisted of 100 patients. All these patients presented in A and E department Nishtar Medical College. Hospital Multan. Patients of any age group and both genders presenting to the emergency department with pain in right lower quadrant of abdomen were included in the study. Patients with presentation of urological, gynecological or surgical problems other than appendicitis and especially patients with mass in right iliac fossa were excluded from the study. Only 11 patients had increased severity of symptoms with score 7 or more on reevaluation with in first 24 hours. These 11 patients underwent appendicectomy. Operative findings and histopathological reports showed that 6 patients had inflammed appendix and the remaining 5 patients had normal appendix. Total number of surgeries performed in our study was 73 [73%]. Among these patients 42 were males and 31 were female. Operative findings and histopathological reports showed that 64 patients [87.68%] had inflammed appendix. Negative appendicectomy rate in our study was 12.32%. In our study we found the positive predictive value for Alvarado Score is 87%. The Alvarado score can be used as an objective criterion in selecting patients for admission. Its application improves diagnostic accuracy and consequently reduces negative exploration and complication rates