Abstract:
The Alvarado Score (AS) is a scoring system used to facilitate the diagnosis of
appendicitis. The study aims to explore the potential of AS to enable antibiotic
therapy for suitable patients, thereby reducing the need for surgery. All patients
aged 16 to 60 who underwent an appendectomy at Teaching Hospital Rathnapura
from 21 September to 15 October 2022 had their ASs calculated and their AS
were compared with their histopathological diagnoses. Using acute appendicitis
as a positive diagnosis and minimal inflammation as a negative diagnosis, a
Receiver Operating Characteristics (ROC) curve was plotted to identify the best
cut off values of the AS for the differentiation of acute appendicitis which would
require surgery from a subacute disease which who could be managed with
antibiotic therapy. Among the 61 patients who underwent appendectomies, 47
were diagnosed with acute appendicitis and 14 with minimal inflammation,
demonstrating a 100% accuracy in the clinical diagnosis. The optimal AS for the
diagnosis of acute appendicitis, as determined by the ROC curve, was 5.5. Using
a cutoff of 6, the diagnostic accuracy was 85.2% (95% CI 73.8% to 93.0%).
Among the 14 patients with minimal inflammation, their AS ranged from 3 to 9
(mean 5.4, SD 1.6), and 10 patients had AS between 3 and 5. At a cutoff value of
4.5 (as suggested by a study conducted in Peradeniya), the specificity in this
current study was only 22%. The characteristic clinical feature of tenderness in
the right iliac fossa, by itself, had a high higher sensitivity of 100% (95% CI
92.5% to 100%) but zero specificity (95% CI 0.0% to 23.2%). The study suggests
that an AS cut-off of 6 was appropriate for the diagnosis of acute appendicitis.
Patients with AS between 3 and 5 could be offered antibiotic therapy instead of
surgery.
