The Modified Alvarado Score Versus the Alvarado Score for the Diagnosis of Acute Appendicitis
Abstract
Background: Decision-making in cases of acute appendicitis may be difficult especially for junior surgeons. Failure to make a diagnosis is a primary reason for the persistent rate of morbidity and mortality. The likelihood of appendicitis can be ascertained by using the Alvarado score, which includes the left shift of neutrophil maturation, yielding a maximum total score of 10, but this parameter is not routinely utilized in many hospitals. In some studies the modified Alvarado score was helpful, reliable and practical in minimizing unnecessary appendectomy.
Objective: The purpose of this study was to evaluate and compare the diagnostic validity of the modified Alvarado score with the Alvarado score for the diagnosis of acute appendicitis.
Materials and Methods: A prospective study of 1 14 patients hospitalized with abdominal pain suggestive of acute appendicitis, from January 2005 to April 2005, was conducted. Data including clinical signs and symptoms and laboratory findings were recorded in Alvarado score and modified Alvarado score record form.
Results: Of 114 hospitalized patients, 106 (93%) had an appendectomy. Of these, 2 (2%) did not have acute appendicitis. In 104 patients who underwent operation, those with an Alvarado score of 9 to 10 (which were almost certain to have appendicitis) had a sensitivity of 48% and a specificity of 100%. 'Those with a score of 7 or 8 (which had a high likelihood of appendicitis) had a sensitivity of 98% and a specificity of 100%. For the modified Alvarado score, those with a score of 9 to 10 had a sensitivity and specificity of 57.7% and 100% respectively. Those with a score of 7 or 8 had a sensitivity of 98% and specificity of 90% respectively. The positive predictive value and accuracy of left shift were 94.1% and 61.4% in the Alvarado score. For extrasign (cough test, Rovsing sign and rectal tenderness) the figures were 94.7% and 83.3% respectively.
Conclusions: In the diagnosis of acute appendicitis, the Alvarado score and the modified Alvarado score are a fast, simple, reliable, noninvasive, repeatable and safe diagnostic modality without extra expense and complications. This study showed that the accuracy of the modified Alvarado score was slightly greater than the Alvarado score in the diagnosis of acute appendicitis.
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