The validity of Modified Alvarado scoring system as a predictor tool for diagnosis of acute appendicitis in a low-income country; a comparative prospective study

Abstract

BACKGROUND: Acute appendicitis is a disease with a well-known long history. The final diagnosis of acute appendicitis is only accurate with histopathological findings after appendectomy. However, the choice to carry out surgical treatment is based exclusively on clinical assessment which do not reach the precise diagnosis of appendicitis. Therefore, Different scoring systems have emerged in order to help physician in decision making and diagnosis of suspicious individuals.Aim: to determine the diagnostic accuracy of Modified Alvarado Scoring System in a low-income country in diagnosis of appendicitis. PATIENTS AND METHODS: This was a cross sectional study that included 200 patients with right iliac fossa pain, suggestive of acute appendicitis. The patients were examined clinically and randomly allocated into 2 groups. The Modified Alvarado Scoring System (MASS) were calculated for the cases group and listed and compared to another control group for which the operative decision was based on the clinical evaluation without relying on a scoring system. All the studied patients went through appendectomy according to overall clinical judgment and never based on MASS only. Specimens were sent to histopathological examination to verify the diagnosis. RESULTS: The results showed that MASS at the cut-off value of ≥ 7 has a sensitivity of 93.33%, specificity of 52.94%, and accuracy of 84.42% and negative appendectomy rate of 17 out of 95 patients (17.8%). Conclusion: MASS is a safe tool in diagnosis of acute appendicitis due to its accepted sensitivity and higher specificity. It could be helpful in low-income countries, where resources are limited.