Prospective evaluation of the Bengezi and Al-Fallouji Modified Alvarado Score for Presumptive Accurate Diagnosis of Acute Appendicitis in University of Port Harcourt Teaching Hospital, Port Harcourt

Abstract

The accurate diagnosis of acute appendicitis (AP) in a patient is valuable to the busy clinician. Decision making in cases of AP poses a clinical challenge especially in developing countries where advanced radiological investigations are not readily available and do not appear cost effective, clinical parameters remain the mainstay of diagnosis. Time and resources wasted on surgical intervention, with the added risks of surgery and anaesthesia, only to discover that this was unnecessary remains a big challenge. This prospective study was carried out to assess the accuracy of the Bengezi and Al-Fallouji modified Alvarado score in presumptive diagnosis of AP and its effect on the negative appendicectomy rate (NAR) at the University of Port Harcourt Teaching Hospital. A retrospective study of the NAR of this hospital between June 2000 and May 2002 was carried out. All consecutive patients (128) who presented with presumptive diagnosis of AP between June 2003 and May 2004 were scored using the Bengezi and Al-Fallouji modified Alvarado scoring system and correlated with histological diagnosis. Patients discharged without surgery based on score, were reviewed in the outpatient's clinic for one month to ascertain that they did not need surgical intervention. The NAR for all appendicectomies performed by surgeons for presumptive diagnosis of AP without scoring between June 2004 and May 2005 was determined as control. Validity of the scoring system was assessed by calculating sensitivity, specificity, positive and negative predictive values. A total of 128 patients were scored. Forty patients with scores less than 4 after eight hours observations and re-evaluation at the Accident and Emergency were discharged without surgery. Eighty eight patients had appendicectomies as treatment for scores 5-10. There were 39 males and 49 females. In eighty patients, the appendix was histologically inflammed and 8 were normal, giving a NAR of 9.09%. High sensitivity of 92.93% and specificity of 92.93% were recorded in the study. The NAR of the retrospective study was 26.4% and 19.05% for the control group operated without scoring. The Bengezi and Al-Fallouji modified Alvarado score is a simple, safe and cost effective aid in diagnosis of acute appendicitis and decreases NAR.