Abstract:
This study aimed to evaluate the Alvarado Score (AS) in increasing the diagnostic
accuracy of appendicitis and assess the possibility of antibiotic therapy, reducing the
need for surgical treatment. A cross sectional study was carried out on all patients
between 16 to 60 years of age who underwent appendicectomy in the Teaching
Hospital Rathnapura, from 21st September to 15th October 2022.The AS were
calculated and compared with the histopathological diagnoses. The indices used for
validating a diagnostic test and the Receiver Operating Characteristics (ROC) curve
were obtained. Sixty-one patients had appendicectomies and acute appendicitis and
minimal inflammation was reported in 47 and 14 patients respectively (100%
accuracy of the clinical diagnosis). Using acute appendicitis as a positive diagnosis
and minimal inflammation as a negative diagnosis, the ideal cut off AS for these
patients, obtained by a ROC curve, was 5.5. Using a cut off of 6, the diagnostic
accuracy was 85.2% (95% CI 73.8% to 93.0%). In the 14 patients who had minimal
inflammation, the AS ranged from 3-9 (mean 5.4, SD 1.6), and 10 patients had AS
between 3-5. The characteristic clinical feature of tenderness in the right iliac fossa,
by itself, had very good sensitivity but very low specificity. Reducing the cut off of
AS to 6 was suitable for the patients studied. Since 10 out of the 14 patients who had
only mild inflammatory changes had AS between 3-5, they could be offered antibiotic
therapy without urgent appendicectomies. However, at a cut off value of 4.5 (as
reported to be the best cut off value by a study carried out at Peradeniya), the
specificity in the current study was only 22%. Reducing the cut off of the Alvarado
Score to 6, and offering antibiotic therapy to patients with AS between 3-5 could be
considered.
