Assessing diagnostic precision of the modified Alvarado score using histopathology as benchmark.

Abstract

Objective: Acute appendicitis (AA) represents a frequent surgical emergency necessitating timely identification and intervention to avoid adverse outcomes. While appendectomy is the standard care, inappropriate clinical diagnosis leads to unnecessary surgeries. The Modified Alvarado Scoring System (MAS) offers a simplified tool to diagnose the entity clinically. Study Design: Cross-sectional Project. Setting: Ayub Teaching Hospital, Abbottabad. Period: 1^st June 2022 to 11^th December 2022. Methods: A total of 185 patients aged 12–90 yrs. with suspected AA who underwent emergency appendectomy were studied. MAS was calculated at admission, and diagnosis was confirmed via histopathological analysis of appendectomy specimen. Diagnostic accuracy was inferred by commuting sensitivity, specificity, PPV, and NPV, with stratification by age and gender. Results: MAS diagnosed 54.6% of cases as AA-positive. Histopathology confirmed AA in 80.5% of patients. MAS correctly identified 62.7% of cases. Inferential analysis revealed 50.3% sensitivity, 15.1% specificity, 62.4% PPV, and 33.3% NPV. Sensitivity was higher in males (89.2%) and in the 26–35 age group (75.6%). Conclusion: MAS is an easily applicable practical tool to diagnose AA: especially at score extremes. However, moderate sensitivity and low specificity highlight the continued importance of clinical acumen. A cut-off score >5 may improve diagnostic accuracy in this population, and region-specific thresholds should be considered.