Abstract

ABSTRACT:
BACKGROUND :
Acute appendicitis is one of the most common causes of abdominal surgical emergencies. It is associated with high morbidity and occasionally mortality related to failure of making an early diagnosis. Modified Alvarado Scoring System is a clinical score which aid in the diagnosis of acute appendicitis.
OBJECTIVE :
To evaluate the overall diagnostic value of Modified Alvarado Scoring System in patients with suspected acute appendicitis and to determine gender differences.
Study design and Setting : A prospective study was conducted in the surgical emergency unit of Baghdad Teaching hospital in a period of five months extending from 18th February to 18th July 2011
PATIENTS AND METHODS :
(100) consecutive patients above the age of (14) years old and of both genders with provisional diagnosis of acute appendicitis were subjected to interview questionnaire covering sociodemographic and clinical characteristics revealing 7 variables based on the Modified Alvarado Scoring System , summation of all scores were calculated for each patient before underwent surgery and all operated appendices were sent for histopathology.
RESULTS:
The total number of included sample were (100) patients , (57%) were females and (43%) were males , (60%) were in the age group of (15-24) years old , (49%) were admitted to hospital within (6-12) hours after onset of symptoms . (87%) had Modified Alvarado Score of ≥7 (57.5% females, 42.5% males) while (13%) had Modified Alvarado Score of <7 (53.9% females, 46.1% males) . Out of those (87%) patients with Modified Alvarado Score ≥ 7 , (92%) patients had acute appendicitis and (8%) patients had normal appendix on histopathological examination. The negative appendectomy rate for patients with score ≥ 7 was 8.1%. While patients with Modified Alvarado Score < 7 were (13%), only (46.1%) of them had acute appendicitis on histopathological examination giving a negative appendectomy rate of 53.9%. The sensitivity , specificity , accuracy and positive predictive value in males were ( 85.4%) , (0%) ,(81.4%) and (94.6%) respectively while in females were (100%) , (58.3%) , (91.2%) and (90%) respectively .
The overall sensitivity , specificity , accuracy , negative appendectomy rate and positive predictive value were (93%) , (50%) , (87%) , (14%) and (91.9%) respectively .
CONCLUSION:
Modified Alvarado Scoring System is helpful in the diagnosis of acute appendicitis.