The modified Alvarado score versus Alvarado score in the diagnosis of acute appendicitis

Abstract EN

Background: Appendicitis is the most common surgical emergency presented daily to emergency surgical department.

The Modified Alvarado Scoring System (MASS) is easier and applicable in the diagnosis of acute appendicitis using extra signs instead of neutrophilic left shift.

Objective: The aim of this study is to compare and evaluate the diagnostic accuracy of MASS versus the Alvarado scoring system.

This study was carried out in Duhok Emergency Teaching Hospital, Iraq, over the period of 12 months, from October 2017 to October 2018.

Materials and Methods: A cross‑sectional study including 200 patients, diagnosed with acute appendicitis by the senior surgeon on call and underwent conventional open appendicectomy.

MASS were applied to all patients preoperatively by author and results of both scores compared to operative and histopathological findings of excised appendix to analyze the efficacy of both scores in the diagnosis of acute appendicitis.

Results: Of 200 patients who underwent operation those with Alvarado score of 9–10 had sensitivity of 88% and specificity of 100%.

Those with a score of 7–8 had sensitivity of 63% and specificity of 68%.

For MASS patients with score of 9–10 had sensitivity of 96% and specificity of 100%, and those with a score of 7–8 had sensitivity of 77% and specificity of 86%.

The higher the score, the sensitivity and specificity increased.

Positive predictive value and accuracy of neutrophilic left shift of Alvarado were 95% and 65%, positive predictive value and accuracy of extra signs of modified Alvarado score were 97% and 84% respectively.

Conclusion: Both Alvarado and MASS are fast, simple, and repeatable systems in the diagnosis of acute appendicitis.

This study reveals that accuracy of MASS is higher than Alvarado score, and the rate of negative appendicectomy can be reduced using this system.