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
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.