The importance of the Alvarado score in differential diagnosis of the pain from the right lower abdominal quadrant]

Acute appendicitis is one of the most common surgical emergency and surgery for this disease is the most frequent performed operation. OBJECTIVE. Our aim is to evaluate the effectiveness of Alvarado scoring system in acute appendicitis diagnosis. STUDY DESIGN. We reviewed the medical records of 346 consecutive patients who underwent appendicectomy for acute appendicitis during one year. METHODS. Our studied group includes 112 men (32.4%) and 234 women (67.6%) with mean age 28.27±13.17 years (range 14 to 81 years). 145 patients were primary managed by laparoscopy with 3.5% (n=12) conversion rate. The appendiceal inflammation was confirmed by histopathology in 286 patients (82.7%). According to recorded data we calculated the Alvarado score for each patient and values ≥ 5 were considered positives.For statistical analysis we used chi square test and Receiver Operator Characteristic (ROC) curve with the significance level less than 0.05. RESULTS. 181 patients (52.3%) have a score < 5 and in 165 cases (47.7%) the values was ≥ 5. The sensitivity of the Alvarado score was 0.60±0.05 and the specificity was 0.96±0.03. The area under the ROC curve was 0.768 with confidence interval 0.715-0.821 (p=0.0001). The increased value of the Alvarado score isn’t predictive for conversion after the initial laparoscopic approach. CONCLUSIONS. The Alvarado scoring system is an easy,simple and cheap instrument for diagnosis of acute appendicitis. This scoring system seems to be more helpful in male patients with a higher predictive value compared to females.