The Predictive Value of Modified Alvarado Score in Diagnosis of Acute Appendicitis

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Assistant Professor, Department of Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Assistant Professor, Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Assistant Professor, Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

5 Resident, Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Tardiness or delay in diagnosis of appendicitis, as the most common cause of acute abdomen around the world, is the most important factor in increasing mortality rate in patients. Therefore, early diagnosis is still a challenge for surgeons to be based on signs and symptoms and laboratory tests to make them sure to decide about the surgery.Methods: In a cross-sectional antegrade study, 200 patient who had come with acute abdominal pain to Modarres hospital emergency room, Tehran, Iran, in 12 months were enrolled; the data of 181 patient were complete that was relevant to our study. Alvarado and modified Alvarado scales were used for data collection by the chief resident of surgery. Pathology report was the standard criterion in this survey.Findings: The accuracy of modified Alvarado score in diagnosis of appendicitis was 81.4% in comparison with 74.0% of Alvarado score. Our modified score with the sensitivity of 88.0% (vs. 67.7%) and the same specificity of 64.4% in detecting normal cases and positive predicting value (PPV) of 66.0% (vs. 41.9%) in diagnosis of acute appendicitis and positive predicting value of 87.3% (vs. 84.1%) in cases of score of more than of 6 was a better score compare to Alvarado score.Conclusion: Adding abdominal pain, male gender, and qualitative C-reactive protein (CRP) to Alvarado score was resulted in obtaining a higher accuracy in the diagnosis of acute appendicitis.

Keywords

References

  1. Di Saverio S, Sibilio A, Giorgini E, Biscardi A, Villani S, Coccolini F, et al. The NOTA Study (Non Operative Treatment for Acute Appendicitis): prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic acid) for treating patients with right lower quadrant abdominal pain and long-term follow-up of conservatively treated suspected appendicitis. Ann Surg 2014; 260(1): 109-17.
  2. Lewis SRR, Mahony PJ, Simpson J. Appendicitis. BMJ 2011; 343: 1-3.
  3. Andersson M, Ruber M, Ekerfelt C, Hallgren HB, Olaison G, Andersson RE. Can new inflammatory markers improve the diagnosis of acute appendicitis? World J Surg 2014; 38(11): 2777-83.
  4. Kariman H, Shojaee M, Sabzghabaei A, Khatamian R, Derakhshanfar H, Hatamabadi H. Evaluation of the Alvarado score in acute abdominal pain. Ulus Travma Acil Cerrahi Derg 2014; 20(2): 86-90.
  5. Hooshmand B, Shokouh-Saremi A, Noferesti A, Yaghoubi MA, Elahifar A. Diagnostic accuracy of Alvarado score in the diagnosis of acute appendicitis. Zahedan J Res Med Sci 2012; 13(8): 18-21. [In Persian].
  6. Mariadason JG, Wang WN, Wallack MK, Belmonte A, Matari H. Negative appendicectomy rate as a quality metric in the management of appendicitis: impact of computed tomography, Alvarado score and the definition of negative appendicectomy. Ann R Coll Surg Engl 2012; 94(6): 395-401.
  7. Apisarnthanarak P, Suvannarerg V, Pattaranutaporn P, Charoensak A, Raman SS, Apisarnthanarak A. Alvarado score: can it reduce unnecessary CT scans for evaluation of acute appendicitis? Am J Emerg Med 2015; 33(2): 266-70.
  8. Nasiri S, Mohebbi F, Sodagari N, Hedayat A. Diagnostic values of ultrasound and the Modified Alvarado Scoring System in acute appendicitis. Int J Emerg Med 2012; 5(1): 26.
  9. Andersson M, Ruber M, Ekerfelt C, Hallgren HB, Olaison G, Andersson RE. Can new inflammatory markers improve the diagnosis of acute appendicitis? World J Surg 2014; 38(11): 2777-83.
  10. Kollar D, McCartan DP, Bourke M, Cross KS, Dowdall J. Predicting acute appendicitis? A comparison of the Alvarado score, the Appendicitis Inflammatory Response Score and clinical assessment. World J Surg 2015; 39(1): 104-9.
  11. Vijay BR. Role of Alvarado score in the diagnosis of acute appendicitis. Int J Res Med Sci 2013; 1(4): 404-8.
  12. Mariadason JG, Wang WN, Wallack MK, Belmonte A, Matari H. Negative appendicectomy rate as a quality metric in the management of appendicitis: impact of computed tomography, Alvarado score and the definition of negative appendicectomy. Ann R Coll Surg Engl 2012; 94(6): 395-401.
Journal of Isfahan Medical School
Volume 34, Issue 388 - Serial Number 388
May and June 2016
Pages 745-750

Files

History

  • Receive Date: 02 June 2016
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics