Diagnostic Challenge of Acute Appendicitis: Appraisal Through Alvarado Score

Background: Acute appendicitis is a common surgical emergency which, even with modern diagnostic facilities, remains a challenging task for the surgeon. The variations in presentation pertaining to time, signs and symptoms can baffle even the very experienced surgeons. The aim of the study was to find out the predictive value of the Alvarado scoring system in diagnosis of acute appendicitis and its clinical applicability. Methods: A total of 113 patients admitted through casualty in Mid-Western General Hospital, Ennis between January and November 2006 with right lower quadrant pain were analyzed prospectively for possible diagnosis of acute appendicitis in the light of Alvarado scoring system, which comprises of signs, symptoms and laboratory findings which are graded individually and divided into four broad groups, namely unlikely (1 - 4), possible (5 - 6), probable (7 - 8), and very probable (9 - 10). Chi-square test was done to establish the relationship of histological diagnosis with scoring system. Results: Out of 113 patients, there were 67 males and 46 females with a mean age of 25.04 years ± 14.21 SD (7 - 81). The Alvarado scoring was found to be 85% accurate for unlikely group, 60% for possible group, 83% for probable group and 100% for very probable group (P = 0.0001). Conclusion: Alvarado scoring system is simple, fast, reliable and easy to use and may increase diagnostic certainty of clinical examination in diagnosis of acute appendicitis. J Curr Surg. 2014;4(4):107-109 doi: http://dx.doi.org/10.14740/jcs244e