Modified Alvarado Scoring System in the Diagnosis of Acute Appendicitis

Abstract

Introduction: Appendectomy is a common emergency procedure. Negative appendectomy rate is up to 33 %. As it is associated with the risks of anesthesia like any operation, it should be avoided where possible. Modified Alvarado score is one of the probable ways to reduce this rate. Our objective of the study was to evaluate its value in reducing the percentage of the negative appendectomy. Methods: A non randomized controlled trial was conducted at Emergency Department of DHQ Hospital Faisalabad over the period of 6 months. 60 patients were divided into two groups. In group A, 1st consecutive 30 patients were included who had indication for appendectomy based on the choice of the surgeon while in group, B 30 patients having indication for appendectomy based on modified Alvarado score 7 or more were included. Surgically removed appendix was evaluated by histopathology for the presence or absence of inflammation. Both groups were compared for the percentage of the negative appendectomy. Results: In group A, overall negative appendectomy rate was 20 % while gender based negative appendectomy rate was 28.5% in Females and 12 % in males. In group B overall negative appendectomy rate was 14 % while gender based negative appendectomy rate was l7.6% in females and 7.6% in males. Over all reduction through modified Alvarado score was insignificant (chi-square 0.480, df 1, p value 0.488). Similarly, statistically significant reduction could not be found both in female (chi-square 0.524, df 1, p value 0.469) and male (chi-square 0.179, df 1, p value 0.672) groups. Conclusion: Modified Alvarado score is not helpful in significant reduction of the over all percentage of the negative appendectomy. Similarly, statistically significant reduction could not be found both in female and male groups. Further methods of evaluation should be used especially in females.