Evaluation of the Alvarado score in the diagnosis of acute appendicitis.

Acute appendicitis may simulate many other acute abdominal illnesses and the exact diagnosis is important for the proper management. The present study was undertaken to evaluate the role of the Alvarado score in the diagnosis of a patient with suspected appendicitis. The study was carried out on 100 patients operated with a presumptive diagnosis of acute appendicitis on the basis of clinical grounds. Alvarado scoring was done in all these patients preoperatively by different personnel. Discriminant analysis of the Alvarado score of all the patients was done to determine the cut-off value in an Indian set-up. The positive and negative predictive values of the Alvarado score were 77.6% and 52.4%, respectively. It is more effective in men and children, with a predictive value of 84% and 92.8%, respectively. Discriminant analysis revealed a cut-off value of > or = 6 rather than the original value of > or = 7. The sensitivity of the Alvarado score increased from 69.2% to 92% with the new cut-off value of > or =6. The Alvarado scoring system can be used in surgical emergency departments to diagnose acute appendicitis. In women, additional investigations may be required to confirm the diagnosis. The original cut-off value given by Alvarado may be changed in the Indian set-up to increase sensitivity.