ALVARADO SCORING SYSTEM

APPLICATION AND DIAGNOSTIC ACCURACY OF ALVARADO SCORING SYSTEM IN PATIENTS WITH APPENDICITIS

Abstract

Objectives: To evaluate the diagnostic accuracy (discrimination) and
implementation performance of Alvarado score. Study Design: Cross sectional study. Setting:
Surgical Unit of Nishtar Hospital Multan under supervision of consultant Surgeons of Department.
Period: 01 year from November 2016 to October 2017. Methodology: For quantitative variables
like age of patients Mean and SD was calculated, and frequency percentages were calculated
for categorical data like gender. Negative appendectomy rate, positive predictive value,
negative predictive value, sensitivity, specificity was calculated by using 2-2 contingency table.
Results: Overall, 100% (n=300) patients enrolled in this study, both genders. Alvarado scoring
at presentation, 15% (n=45) patients were categorized into Group I. 13% (n=39) patients were
included in Group II. While, 72% (n=216) were enrolled in Group III. Diagnostic test was positive
in 223 patients. While, acute appendicitis was confirmed histo-pathologically in 160 patients.
Gangrenous appendicitis observed in 3 patients. Chronic appendicitis, perforated appendicitis,
appendicular abscess, no specific pathology, gangrenous intestine and salpingo-oophoritis
was observed as 31, 6, 9, 6, 3 and 5 respectively. There were 174 patients true positive, 49 were
false positive, 59 were false negative and 18 were true negative. Sensitivity, specificity, negative
predictive value and negative predictive value were 74.68% 26.87%, 78.02% and 23.37%
respectively. Conclusion: Alvarado scoring system is useful tool in diagnosis of appendicitis
in pre-operative period which can be useful for surgeons at any level of health care. According
to our study observations Alvarado scoring system has better sensitivity 74.68% but specificity
26.87% which shows that Alvarado scoring system is helpful in diagnosis of appendicitis but not
much helpful in preventing negative laparotomies.