DIAGNOSTIC ACCURACY OF ALVARADO SCORING SYSTEM IN ACUTE APPENDICITIS

Abstract

Appendicitis is a global disease with higher incidence in developing countries. This
report aimed to understand more about the diagnostic accuracy of Alvarado score and
its components. The study sought to assess the discrimination (diagnostic accuracy) and
calibration performance of the Alvarado score and to evaluate its usefulness in reducing
the percentage of negative appendectomy in our hospital. A cross-sectional study was
conducted, comprising 104 patients, admitted to general surgery department at Misurata
Medical Center, from 1st January 2022 to 31 December 2022 with a preliminary
diagnosis of acute appendicitis. Children younger than 6 years and pregnant ladies were
exclude from the study. All patients were given specific scores according to the
variables of the Alvarado scoring system and then divided into 3 groups: Group 1: score
3 or less (unlikely acute appendicitis), Group 2: score 4–6 (probably acute appendicitis),
and Group 3: score 7 or more (likely acute appendicitis). The efficacy of Alvarado
scoring system was assessed by calculating sensitivity, specificity, positive predictive
value, negative predictive value and negative appendectomy rate. Out of 104 cases, 71
were males and 33 females. At score of 7 or more, appendicitis was confirmed in 94
patients out of 95 patients (99%), while at scores < 7 appendicitis was confirmed in 5
patients out of 9 patients (56%). The sensitivity was 94%, the specificity was 75%, the
positive predictive value was 98% and the negative predictive value was 33%. In the
present study, negative appendectomy rate was 3.7%. Alvarado score can be used
effectively in our setup to reduce the incidence of negative appendectomies. The
scoring system is a useful diagnostic tool regarding sensitivity and positive predictive
value. It is cheap, reliable, and can be easily applied.