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Impact of the alvarado score on the diagnosis of acute appendicitis: comparing clinical judgment, alvarado score, and a new modified score in suspected appendicitis: a prospective, randomized clinical trial

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Abstract

Background

The Alvarado score is a clinical scoring system used in the diagnosis of acute appendicitis. This study aimed to compare the reliability of the Alvarado score and clinical judgment and to refine the score to make it easier to use.

Methods

In this prospective, randomized study, patients presenting at the authors’ outpatient department with suspected appendicitis during a 1-year period were assigned in weekly alternation to either group A or group B. The group A patients were treated on the basis of their Alvarado score, and the group B patients underwent treatment based on clinical judgment. The correctness of the methods was assessed by evaluation of the final histology. Statistical comparison of the data was performed using SPSS 20.

Results

The study investigated 269 patients (131 in group A and 138 in group B). The groups were homogeneous in terms of mean age, gender, body mass index, and American Society of Anesthesiologists score. The number of negative appendectomies was 12 (9.16 %) in group A versus 5 (3.6 %) in group B (p = 0.063). The clinical judgment had better specificity and sensitivity than the Alvarado score. For that reason, the specificity of the Alvarado score was refined using statistical methods, with weighting of certain clinical data and inclusion of new ones (e.g., ultrasound investigation). Consequently, the area under the curve by receiver operating characteristic analysis gradually increased, and the Alvarado score became more accurate.

Conclusion

The study findings showed clinical judgment to be more reliable in the diagnosis of acute appendicitis than the Alvarado score, but the score is a useful diagnostic aid, especially for young colleagues. The use of the new scoring system has become easier. It includes fewer criteria as well as an important and sensitive predictor: the ultrasound investigation.

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References

  1. Anderson JE, Bickler SW, Chang DC, Talamini MA (2012) Examining a common disease with unknown etiology: trends in epidemiology and surgical management of appendicitis in California 1995–2009. World J Surg 36:2787–2794

    Article  PubMed  Google Scholar 

  2. Gilmore OJ, Browett JP, Griffin PH, Ross IK, Brodribb AJ, Cooke TJ et al (1975) Appendicitis and mimicking conditions: a prospective study. Lancet 2:421–424

    Article  CAS  PubMed  Google Scholar 

  3. András A (2009) Változások az akut appendicitis epidemiológiájában, etiológiájában, diagnosztikájában és terápiájában (changes in epidemiology, etiology, diagnostics, and therapy of acute appendicitis). Orv Hetil 10:443–446

    Google Scholar 

  4. Raja AS, Wright C, Sodickson AD, Zane RD et al (2010) Negative appendectomy rate in the era of CT (an 18-year perspective). Radiology 256:460–465

    Article  PubMed  Google Scholar 

  5. Jaffrey RB, Laing FC, Lewis FR (1987) Acute appendicitis high resolution real-time ultrasound findings. Radiology 163:11–14

    Google Scholar 

  6. Collaborative SCOAP, Cuschieri J, Florence M et al (2008) Negative appendectomy and imaging accuracy in the Washington State Surgical Care and outcomes assessment programme. Ann Surg 248:557–563

    Google Scholar 

  7. Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15:557–564

    Article  CAS  PubMed  Google Scholar 

  8. Al-Hashemy AM, Seleem MI (2004) Appraisal of the modified Alvarado score for acute appendicitis in adults. Saudi Med J 25:1229–1231

    PubMed  Google Scholar 

  9. Impellizzeri P, Centonze A, Antonuccio P, Turiaco N, Cifalà S, Basile M et al (2002) Utility of a scoring system in the diagnosis of acute appendicitis in pediatric age: a retrospective study. Minerva Chir 57:341–346

    CAS  PubMed  Google Scholar 

  10. Chan MY, Tan C, Chiu MT, Ng YY (2003) Alvarado score: an admission criterion in patients with right iliac fossa pain. Surgeon 1:39–41

    Article  CAS  PubMed  Google Scholar 

  11. Pruekprasert P, Maipang T, Geater A, Apakupakul N, Ksuntigij P (2004) Accuracy in diagnosis of acute appendicitis by comparing serum C-reactive protein measurements, Alvarado score, and clinical impression of surgeons. J Med Assoc Thai 87:296–303

    PubMed  Google Scholar 

  12. Denizbasi A, Unluer EE (2003) The role of emergency medicine resident using the Alvarado score in the diagnosis of acute appendicitis compared with the general surgery resident. Eur J Emerg Med 10:296–304

    Article  PubMed  Google Scholar 

  13. Jo YH, Kim K, Rhee JE, Kim TY, Lee JH, Kang SB et al (2010) The accuracy of emergency medicine and surgical residents in the diagnosis of acute appendicitis. Am J Emerg Med 28:766–770

    Article  PubMed  Google Scholar 

  14. Douglas CD, Macpherson NE, Davidson PM, Gani JS (2000) Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. BMJ 14:919–922

    Article  Google Scholar 

  15. Lee SL, Ho HS (2003) Ultrasonography and computed tomography in suspected acute appendicitis. Semin Ultrasound CT MR 24:69–73

    Article  PubMed  Google Scholar 

  16. Horton MD, Counter SF, Florence MG, Hart MJ (2000) A prospective trial of computed tomography and ultrasonography for diagnosing appendicitis in the atypical patient. Am J Surg 179:379–381

    Article  CAS  PubMed  Google Scholar 

  17. Parker L, Nazarian NL, Gingold EL, Palit CD, Hoey CL, Frangos AJ (2014) Cost and radiation savings of partial substitution of ultrasound for CT in appendicitis evaluation: a national projection. AJR Am J Roentgenol 202:124–135

    PubMed  Google Scholar 

  18. Sooriakumaran P, Lovell D, Brown R (2005) A comparison of clinical judgment vs the modified Alvarado score in acute appendicitis. Int J Surg 3:49–52

    Article  PubMed  Google Scholar 

  19. Kurane SB, Sangolli MS, Gogate AS (2008) A one-year prospective study to compare and evaluate diagnostic accuracy of modified Alvarado score and ultrasonography in acute appendicitis, in adults. Indian J Surg 70:125–129

    Article  PubMed Central  PubMed  Google Scholar 

  20. Pouget-Baudry Y, Mucci S, Eyssartier E, Guesdon-Portes A, Lada P, Casa C et al (2010) The use of the Alvarado score in the management of right lower quadrant abdominal pain in the adult. J Visc Surg 147:e40–e44

    Article  CAS  PubMed  Google Scholar 

  21. Ohle R, O’Reilly F, O’Brien KK, Fahey T, Dimitrov BD (2011) The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med 28:139

    Article  Google Scholar 

  22. Owen TD, Williams H, Stiff G, Jenkinson LR, Rees BI (1992) Evaluation of the Alvarado score in acute appendicitis. J R Soc Med 85:87–88

    CAS  PubMed Central  PubMed  Google Scholar 

  23. Arain GM, Sohu KM, Ahmed E, Haider W, Naqi SA (2001) Role of Alvarado score in diagnosis of acute appendicitis. Pak J Surg 17:41–46

    Google Scholar 

  24. Khan I, ur Rehman A (2005) Application of alvarado scoring system in diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad 17:41–44

    PubMed  Google Scholar 

  25. Singh K, Gupta S, Pargal P (2008) Application of Alvarado scoring system in diagnosis of acute appendicitis. JK Sci 10:84–86

    Google Scholar 

  26. Al Qahtani HH, Muhammad AA (2004) Alvarado score as an admission criterion for suspected appendicitis in adults. Saudi J Gastroenterol 10:86–91

    PubMed  Google Scholar 

  27. Abdeldaim Y, Mahmood S, McAvinchey D (2007) The Alvarado score as a tool for diagnosis of acute appendicitis. Ir Med J 100:342

    CAS  PubMed  Google Scholar 

  28. Gwynn LK (2001) The diagnosis of acute appendicitis: clinical assessment versus computed tomography evaluation. J Emerg Med 21:119–123

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by the European Union and cofunded by the European Social Fund under the project Telemedicine-Focused Research Activities on the Field of Mathematics, Informatics, and Medical Sciences, project number TÁMOP-4.2.2.A-11/1/KONV-2012-0073.

Disclosures

Eszter Mán, Zsolt Simonka, Ákos Varga, Ferenc Rárosi, and György Lázár have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, University of Szeged, Pécsi u. 6, Szeged, 6720, Hungary

    Eszter Mán, Zsolt Simonka, Ákos Varga & György Lázár

  2. Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary

    Ferenc Rárosi

  3. Bolyai Institute, University of Szeged, Szeged, Hungary

    Ferenc Rárosi

Authors
  1. Eszter Mán
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  2. Zsolt Simonka
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  3. Ákos Varga
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  4. Ferenc Rárosi
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  5. György Lázár
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Corresponding author

Correspondence to György Lázár.

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Mán, E., Simonka, Z., Varga, Á. et al. Impact of the alvarado score on the diagnosis of acute appendicitis: comparing clinical judgment, alvarado score, and a new modified score in suspected appendicitis: a prospective, randomized clinical trial. Surg Endosc 28, 2398–2405 (2014). https://doi.org/10.1007/s00464-014-3488-8

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  • DOI: https://doi.org/10.1007/s00464-014-3488-8

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