A retrospective evaluation of Alvarado score in diagnosing acute appendicitis in a tertiary care hospital at Pondicherry
Keywords:Appendicitis, Negative appendectomy rate, Clinical score
Background: Acute appendicitis is a common and sometimes confusing cause of acute abdomen in all age groups. Diagnosis of appendicitis can be difficult, occasionally taxing the diagnostic skills of even the most experienced surgeon. Despite the increased use of USG, CT, the rate of misdiagnosis of appendicitis has remained the same (15.3%). To evaluate the usefulness of the Alvarado score as a simple and reliable tool in preoperative diagnosis of acute appendicitis.
Methods: This retrospective study conducted on 97 cases includes all patients who were admitted with a clinical diagnosis of acute appendicitis for a period of one year from February 2019 to January 2020 at IGMCRI Pondicherry with clinical suspicions of acute appendicitis were included in the study. The modified scoring system is based on 3 signs, 3 symptoms, and 1 laboratory finding. The patient was classified as males, females, and children (<12 years). These were further grouped based on the scores 7-9, 5-6, and <5.
Results: A total of 80 patients with a score of 7-9 and 5-6 were operated on. Among males with a score of 7-9, 35 patients were operated and 34 were found to have an inflamed appendix. Females with scores 7-9, 16 were operated and 11 were found to have an inflamed appendix.
Conclusions: Alvarado scores significantly reduce the number of negative laparotomies without increasing the overall rate of appendicular perforation. It is very effective in men and children but diagnostic laparoscopy or ultrasonography is advised to minimize the high false-negative rate in women.
Addiss DG, Shaffer N, Fowler BS, Tauxe RV et al. The epidemiology of appendicitis and appendectomy in the US. Am J Epidemiol. 2012:132:910-11.
Ajmani ML, Ajmani K. The position, length, and arterial supply of vermiform appendix. Anat Anz. 2005:153:369.
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 2009;15:557.
Bower RJ, Bell MJ, Terhberg JL. Diagnostic value of the white cell count and neutrophil percentage in the evaluation of abdominal pain in children Surg Gynecol Obstet. 2009;152(424):19-23.
Brunicardi FC, Dunn DL, Hunter JG, Pollock RE, Anderson DK, Billiar TR et al. Schwartz's principles of surgery Mc Graw Hill Companies, Inc; 8th edition. 2005;111935.
Burchard K, Kjaeldgaard A. Investigation and analysis of the position, fixation, length and Embryology of the vermiform appendix. Acta Chir Scand. 2009;139:293.
David CH, Sabiston JR. Acute appendicitis in-The textbook of surgery, WB Saunders international, 15th edition. 2007;964-70.
Fishin P, Kelvin FM, Rice RP. Non-specificity of Barium enema findings in acute appendicitis. AJR. 2009;143:99-102.
Flum DR, Morris A, Koepsell T, Dellinger EP. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. Arch Surg. 2002;137:799.
Fuchs JR, Schomberg JS, Shortsleeve MJ, Schuler JG. Impact of abdominal CT imaging on the management of appendicitis an update. J Surg Res. 2019;106:131.
Hale DA, Molloy M, Pearl RH et al: Appendectomy: A contemporary Appraisal. Ann Surg 2010 225: 252.
Jeffery RB, Jain KA, Nghiem HV. Sonographic diagnosis of acute appendicitis. Interpretive pitfalls Am J Roentgenol. 2009;162:55.
Korner H, Sondenna K, Soreide JA. Incidence of acute nonperforated and perforated appendicitis: Age-Specific and sex-specific analysis. World J Surg. 2009;21;313.
Miranda R. Johnston AD, O’Leary JP. Incidental appendectomy frequency of pathologic abnormality Ann Surg. 2008;46;355.
Puig S, Hormann M, Rebhandl W. Ultrasound as a primary diagnostic tool about negative appendectomy: six years’ experience. Radiology. 2003;226;101-5.
Rajagopalan AE, Mason JH, Kennedy N, Pawlikowski J. The value of Barium enema in the diagnosis of acute appendicitis. Arch Surg. 2010;112:531-3.
Raman SS, Lu DSK, Kadell BM, Vodopich DJ, Sayre J, Cryer H. Accuracy of non-focused helical CT for diagnosis of acute appendicitis A 5 years Review. Am J Roentgenol. 2002;1178:1319.
Russel RCG, Williams NS, Bulstrode Christopher JK. Bailey and love the short practice of surgery. Arnold publishers. 2004;1203-18.
Smith DE, Kivchmer NA, Steward DR. Use of Barium enemas in the diagnosis of acute appendicitis and its complications Am. J Surg. 2008;138:829-32.
Stroman DL, Bayouth CV, Kuhn JA. The role of computed tomography in the diagnosis of acute appendicitis. Am J Surg. 1999;178:485.