Acute appendicitis: diagnostic accuracy of alvarado scoring system: experience at a public sector hospital in Pakistan

Objective: To assess the diagnostic accuracy of the Alvarado score in acute appendicitis

---

Study design: A cross sectional study

---

Place and duration: The study was conducted at the Accident and Emergency Department of KVSS Site Hospital during a period of 12 months from 1 Jan 2012 to 31 Dec 2012

---

Methodology: Hundred and ten consecutive patients who attended emergency department of KVSS Site Hospital with provisional diagnosis of acute appendicitis were included in this study after informed consent. Alvarado score was recorded and according to the aggregate score, patients were divided into two groups with scores of <5 and >/=5. The clinical diagnoses and operative findings of patients who were subjected to surgery for Alvarado score>/= 5 were compared with their histopathology reports. A self designed questionnaire was used to record relevant data including patients' age, gender, weight, Alvarado score and histopathology

---

Result: Out of total 110 cases [79 males, 31females], 28.2% [n=31] belonged to Group-A and 71.81% [n=79] belonged to Group-B. Surgical procedures were performed in 98.2% of cases, along with conservative treatment. Final diagnosis by histopathology was confirmed in 71.3% [n=77] cases. The overall negative appendectomy rate was 28.7% [males: 28.2%, females: 30%]. Sensitivity and specificity of Alvarado scoring system was found to be 93.5% and 80.6% respectively. Positive and negative predictive values were 92.3% and 83.3% respectively and accuracy was 89.8%

---

Conclusion: The Alvarado score is highly effective and non-invasive in the diagnosis of acute appendicitis