ALVARADO SCORE;

Validity in diagnosing acute appendicitis

Abstract

Objective: To determine the validity of Alvarado score in diagnosing acute appendicitis keeping histopathology of appendix
as gold standard. Study Design: Cross sectional (Validation) study. Place and Duration of Study: Department of Surgery Combined
Military Hospital Rawalpindi from April 2009 to October 2009. Materials and Methods: 90 patients with clinical suspicion/diagnosis of
acute appendicitis were included in study. All were divided into two groups on the basis of Alvarado score. Group I with score 7-10, who
underwent open appendicectomy. Group II(a) with 5-6, who were observed in hospital. Group II(b) with< 4 were discharged. In all
operated cases appendix was sent for histopathology. Alvarado score was compared with histopathology (gold standard). Results: Male
to female ratio was 3.5 :1. Mean age was 25.34. Alvarado score had overall 88.13% sensitivity, 70.96% specificity, 85.24% PPV,
75.86%NPV and 16.90% negative appendicectomy rate. Whereas in male patients it had 90.74% sensitivity, 75% specificity, 92.45%PPV,
70.58%NPV and 6.89% negative appendicectomy rate. In female it had 60% sensitivity, 66.66% specificity, 37.5% PPV, 83.33%NPV and
38.46% negative appendicectomy rate. Conclusion: Alvarado score is very accurate for acute appendicitis in male patients. Patients with
score 4 can safely be discharged home. USG should be performed routinely in female patients to improve the diagnostic accuracy of
Alvarado score.