TO EVALUATE THE ACCURACY OF ALVARADO SCORE IN THE DIAGNOSIS OF ACUTE APPENDICITIS-A PROSPECTIVE STUDY

OBJECTIVES The aim of our study is to correlate the diagnosis of acute appendicitis based on the Alvarado scoring system with histological findings of the operated specimen and to analyse the incidence of negative appendectomy using this scoring system. METHODS A prospective study on 100 patients with clinical suspicion of acute appendicitis at MGIMS, Jaipur, from July 2011 to Dec 2012 was carried out. All patients were divided into three groups on the basis of Alvarado scoring system. USG, TLC and urinalysis was carried out in all patients. The decision of admission and surgery was made independent of the score. All removed appendix specimen were sent for histopathological examination. RESULTS Patients were in the range of 10-59 years with a mean age of 26.27. The male: female ratio in our study was 2.3:1. Abdominal pain was localized to RLQ in 89 patients, migration of pain from the umbilical region to right lower quadrant was present in 60%. Right lower quadrant tenderness was seen in 95% cases. Rebound tenderness was present in 68% cases. Seventy five (75%) cases were in the last score range of 7-10, suggestive of acute appendicitis with 54(72%) males and 21(28%) females. A statistically significant association between Alvarado score and histopathological diagnosis was found. The sensitivity, specificity and positive predictive value, negative predictive values of the scoring system were 80%, 70%, 96% and 28% respectively. The diagnostic accuracy of the scoring system was 79%. CONCLUSION Though Alvarado score is easy, cheap and useful tool in preoperative evaluation of suspected cases of acute appendicitis, the final decision to operate cannot be based on Alvarado score only, particularly in the score below 7, as the diagnostic accuracy in our study was 79% only. Additional investigations like ultrasonography and computerized tomography required to arrive at a final diagnosis, especially in elderly patients, female patients and patients with equivocal score and low scores.