Does the Alvarado Score combined with computed tomography reduce negative appendectomy?

Murat Akıcı; Emre Ballı

doi:10.26900/hsq.2905

Authors

Murat Akıcı Afyonkarahisar Health Sciences University / Türkiye 0000-0001-6739-0670
Emre Ballı Afyonkarahisar Health Sciences University / Türkiye 0000-0002-3201-9756

10.26900/hsq.2905

Abstract

Acute appendicitis is the most common cause of abdominal surgery. The lifetime probability of experiencing appendicitis is 7%. History and findings are crucial in the diagnosis of appendicitis. However, many other conditions must be considered in the differential diagnosis. Diagnosing appendicitis can be difficult, especially in small centers lacking imaging centers. Therefore, scoring systems have been developed to robustly predict the diagnosis of appendicitis without imaging methods. The most commonly used is the Alvarado Score. When the Alvarado Scores and computed tomography scans of the 360 patients included in the study were compared: The mean Alvarado Score of 280 patients (77.82%) diagnosed with suppurative appendicitis on computed tomography was 6.59±1.53; the mean Alvarado Score of 12 patients (3.40%) diagnosed with perforated appendicitis was 8.27±1.13; the mean Alvarado Score of 54 patients (15.13%) interpreted as suspected appendicitis was 6.19±2.67; and the mean Alvarado Score of 14 patients (3.88%) interpreted as normal appendix was 5.62±1.39. According to these results, we see that the prediction of appendicitis diagnosis in computed tomography imaging of patients with high Alvarado Scores is high. The preoperative mean Alvarado Score of 293 patients (81.4%) diagnosed with suppurative appendicitis according to pathology results was 6.7±1.55. The mean Alvarado Score for 44 patients (12.3%) with perforated appendicitis was 6.91±1.56, and for 23 patients (6.3%) with normal appendixes, the mean Alvarado Score was 5.49±1.47. According to these results, the lower Alvarado Score in patients without appendicitis compared to those with acute appendicitis and perforated appendicitis was found to be statistically significant (p=0.001). In conclusion, suspected appendicitis is suspected in patients with an Alvarado Score of 5-6. We believe that using computed tomography (CT) in these patients can more accurately diagnose appendicitis and reduce the negative appendectomy rate.

Keywords:

Alvarado Score ultrasound computed tomography appendicitis perforation negative appendectomy

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