Modified alvarado score: is there a role for reducing rate of negative appendicectomy?

ABSTRACT

To evaluate the usefulness of modified Alvarado scoring system in reducing rate of negative appendicectomy. In the period from July 2002 to April 2004, 122 patients with lower right abdominal pain were admitted and subjected to this prospective trial According to the modified Alvarado score [MAS] patients had ether a score = 7 or a score > 7. For those patients with mostly suspected appendicitis [score > 7] [73 patients] appendicectomy was performed. For those patients with possible appendicitis [score < 7] [14 patients] diagnostic laparoscopy was performed whenever indicated to confirm or refute the diagnosis The presence of a high score [over 7] was found to be an easy and satisfactory aid to early diagnosis of appendicitis in children and men with a diagnostic accuracy of 100%, 96.1% respectively, while in women, it falls disappointingly short of expectations [67%] with false positive rate over 30%. In patients with low score [<7] the diagnostic accuracy of MAS was 60%, 57.1%, and 50% in men, women and children respectively without statistically significant difference. However the use of laparoscopy reduced the negative appendix rate to zero% in this group. The Modified Alvarado score [did well in reducing rate of negative appendicectomy in children and men but diagnostic laparoscopy should be considered in women particularly in the childbearing age and in patients with possible appendicitis [score < 7]