Diagnostic Accuracy of Alvarado Scoring System in the Management of Acute Appendicitis

Objective: To determine the diagnostic accuracy of Alvarado Scoring System in the management of acute appendicitis. Study design: This study was carried out in department of surgery LUMHS, Jamshoro, Hyderabad from January, 2007 to December, 2008. A total of 227 patients were included in this study. Patients were assigned Alvarado scoring system and divided into three groups. Group 1:(Score l- 4) Immediate discharge and advise for follow- up. Group 2:(Score5-7) Observational group. Group 3:( Score 810) Immediate appendectomy. Result: Out of 227 patient, 108(47.6%) patients presented with migratory pain, 44(19.4%) presented with pain right iliac fossa, 21(9.2%) with pain in whole abdomen and 54(23.8%) with pain in para umbilical region. Out of 227 patients, 33(14.53%) had avarado score1-4 and all patients discharged with advise for follow up and 3 patients readmitted and required surgical intervention. 49(21-59%) patients had inflamed score 5 and out of 49, 37 patients required surgical intervention and 12 patients discharge after 24 hours. 61(26.87%) had score6-7 and all patients required surgical intervention. 84(37.1%) patients had score 8-10 and all underwent surgery. Out of 227 patients, 185 underwent surgery. Out of 227, 185 patients underwent surgery and out of these, 145(78.06%) patients had acute inflammatory appendix and in 35(18.9%) patients,18-94% appendix was found normal, 5(2.5%) patients having ruptured ovarian cyst, mesenteric cyst, lymph adenitis and meckles diverticulum. Specimen of` 147 patients, out of 185 operated, were submitted for histopathology. The normal appendix was found in 27(18.4%) patients and inflamed appendix was found in 120(81.6%) patients. Conclusion: Alvarado scoring system is reliable, cheap, quick and handy tool in emergency department and in rural area, this system is helpful in diagnosis/management of acute appendicitis.