A Comparative Study of Modified Alvarado Score Vs Routine Clinical Assessment in the Management of Acute Appendicitis

Abstract

Background: Pain in right Iliac fossa is one of the most common presenting symptom in the surgical emergency in which acute appendicitis is the most probable amongst the differentials. Patients with equivocal signs and symptoms pose a significant diagnostic dilemma for which they are admitted for observation. Aim: To compare the efficacy of modified Alvarado scoring system with the routine clinical diagnosis. Study design: A randomized controlled trial was set up to compare clinical diagnosis (control group) with a diagnostic protocol using modified Alvarado scoring system (intervention group). Setting: This study was conducted in a government administered tertiary care referral center (Mayo Hospital Lahore), Pakistan, from Septembers 15, 2019 to September 14, 2020. Method: A total of 256 patients referred to surgical department with suspected appendicitis were included in the study. Patients above the age of 12 years were included in the study. Patients were randomly divided into two groups. Group A included 128 patients who were assessed on the basis of the Modified Alvarado score while the Group B also included 128 patients which were assessed on routine clinical evaluation. Histopathology was the Gold Standard which determined the Diagnostic Accuracy (DA) and Negative Appendectomy Rate (NAR), which were duly recorded. Results: The Diagnostic Accuracy (DA) of the Group A evaluated on the Modified Alvarado Scoring System was 88% in which 113 out of 128 patients were positive for acute appendicitis on histopathology while Negative Appendectomy Rate(NAR) was 12%.Only 15 out of 128 were negative on histopathology . However the Group B had a (DA) of 79% in which 101 patients out of 128 were proven positive through the histopathology while (NAR) was 21%. The mean age of the was found to be 25.34 years with a male to female preponderance ratio of 1.22:1 Conclusion: we have found the Alvarado scoring system to be an effective and a convenient scoring tool. We recommend its regular application in the emergency for the diagnosis of Acute Appendicitis. Keywords: Alvarado score, Acute appendicitis, Histopathology, Clinical diagnosis.