Assessment of the accuracy of using the combination of modified alvarado score and abdominal ultrasound in acute appendicitis


  • Anita Samraj Department of General Surgery, Saveetha Medical College and Hospital Chennai, Tamil Nadu, India
  • Dharun Kumar S. Department of General Surgery, Saveetha Medical College and Hospital Chennai, Tamil Nadu, India



Acute appendicitis, Alvarado score, Histopathological examination, Ultrasonogram


Background: Appendix is a worm shaped blind tube of varying length (2-25) cm opening into the caecum 2cm below the ileocaecal valve in posteromedial valve. It is the only organ in the body that has no constant position. Incidence of acute appendicitis parallels that of lymphoid development with peak incidence in early adulthood. It is rare before the age of two. Before puberty the incidence of acute appendicitis is equal in both sexes. But after puberty there is a slight male preponderance. The objective of this study was to evaluate assessment of accuracy of the combined use of modified Alvarado scoring system and ultrasound in the diagnosis of acute appendicitis.

Methods: Around 136 patient’s acute appendicitis were subjected to estimation of total leucocyte count and plain x-ray abdomen after thorough history evaluation and clinical examination before surgery. Alvarado score was found in all cases. All of them were operated on the day of admission itself and preoperative findings were noted. All appendicectomy specimens were subjected to histopathological examination (HPE).

Results: Acute appendicitis is the most common surgical abdominal emergency in our hospital. Acute appendicitis is more common in males and the commonest age group affected is 21 - 30 years. Right iliac fossa pain is the most common presenting symptom followed by nausea/vomiting. In diagnosis of acute appendicitis Alvarado score has a high diagnostic value (82.5%).

Conclusions: The combined use of modified Alvarado score with ultrasonogram done in patients with equivocal or low Alvarado score is useful in identifying the missed-out cases thereby preventing diagnostic delay and its attendant complications. Appendices that appear to be normal on macroscopic inspection may show features of acute appendicitis on histopathologic examination.

Author Biography

Anita Samraj, Department of General Surgery, Saveetha Medical College and Hospital Chennai, Tamil Nadu, India



Hoffmann J, Rasmussen OO. Aids in the diagnosis of acute appendicitis. Br J Surg. 1989;76:774-9.

Jade R, Muddebihal MU, Naveen N. Modified Alvarado score and its application in the diagnosis of acute appendicitis. Int J Contemporary Med Res. 2016; 3(5): 1398-400.

Baidya N, Rodrigues G, Rao A. Evaluation of Alvarado scores in acute appendicitis. Internet J Surg. 2007;9:1-3.

Teicher I, Landa B, Cohen M, Cabnick LS, Wise L. scoring system to aid in the diagnosis of acute appendicitis. Ann Surg. 1983;198:753-9.

Peterson MC, Holbrook JH, Hales D. Contribution of history, physical examination, and laboratory investigations in making medical diagnosis. West J Med. 1992;156:163-5.

Fengo G, Lindberg G, Blind P, Enochsson L, Oberg A. Diagnostic decision in suspected acute appendicitis: validation of a simplified scoring system. Eur J Surg. 1997;163:831- 8.

Hasanuzzaman M. Diagnosis of acute appendicitis evaluation through modified Alvarado score by O. Bengazi and Al Fallouji (Dissertation). Dhaka: BCPS; 2004.

Ikramullah K, Attaurrehman. Application of Alvarado scoring system in diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad. 2005;17(3):41-4.

Ford R, Passinauil W, Morse M. diagnostic ultrasound for suspected appendicitis. Does the aided cost produce a better out come? Am Surg. 1994;60:895-8.

Al Qahtani HH, Muhammad AA. Alvarad score as an admission criterion for suspected appendicitis in adults. Saudi J Gastroenterol. 2004;10:86-91.

Roth C, Tello R, Sutherland K. Prediction rule for Etiology of vague abdominal pain in the emergency room. Utility for imaging triage. Invest Radiol. 2002;37:552-6.

Townsend MC, Beauchamp DR, Evers MB, Mattox KL. Sabiston text book of surgery. New Delhi: Elsevier; 2005:1884-1889.

Addiss DG. Shaffer N. The epidemiology of appendicitis and appendicectomy in United States. Am J Epi. 1990;132:910-1.

Sivit C. Imaging children with acute right lower quadrant pain. Pediatr Clin North Am. 1997;44:575-89.

Dado G, Anania G, Baccarani U. Application of a clinical score for the diagnosis of acute appendicitis in childhood. J Peditr Surg. 2000;35:1320-2.






Original Research Articles