USE OF A MODIFIED ALVORADO SCORE IN THE DIAGNOSIS OF ACUTE APPENDICITIS

Abstract

ABSTRACT
Background: The negative appendicectomy rates have remained high. The integration of
clinical scores into the diagnostic process in acute appendicitis has had the purposes of
improving decision making and reducing the negative rates in this common condition. The
performance of these score systems have however, not been uniform.
Objective: To assess the usefulness of a modified Alvorado score (1986) to predict groups of
patients with suspected appendicitis for definite surgery, observation or discharge from
hospital.
Design: Prospective study.
Setting: Kenyatta National Hospital (KNH), a central referral and teaching hospital in
Nairobi, Kenya.
Patients: One hundred and eighty nine patients with suspected acute appendicitis were
studied over a period of twelve months.
Methods: Five symptoms and four signs were assigned numerical values and the patients
scored out of a total of 10 points. A score of >7 predicted mandatory operation, 5-6
observation and score 1-4 predicted those not considered for surgery. The decision to operate
was the prerogative of the surgeon or surgical resident based on overall clinical suspicion and
not the diagnostic score.
Results: The proportion of patients with scores >7 was 40.7%. The mean score was 6.02. The
mean ages and the gender ratios were similar across score groups. The negative appendicectomy
rate was 17.6% for group 1-4, 16.5% for 5-6 and 19.7% for > 7. These were similar to the
overall negative rate of 18% based on clinical suspicion. The overall sensitivity and sensitivity
for the scoring system was 80.3% and 16.8% respectively.
Conclusion: High scores were found to perform poorly in predicting diagnosis of acute
appendicitis preoperatively and in the reduction of negative appendicectomies. The integration
of a scoring system does not offer advantage over degree of clinical suspicion.