Role of the Alvarado score in the diagnosis of acute appendicitis

Introduction: Acute appendicitis is the most frequent surgical emergency in the Emergency Department and diagnosis is mainly based on clinical examination. However, its clinical features are sometimes deceptive as well as the wide range of differential diagnoses are frequently sources of diagnostic errors and of a delayed management. In order to reduce these diagnostic difficulties, the number of complementary examinations and abusive surgical procedures, several clinical scores have been developed, including the Alvarado score. The objective of this study aimed to apply this score to a population of adult patients presenting with pain in the right iliac fossa in order to evaluate its performance as well as its limits. Methods: We conducted a prospective study of all patients over the age of 15 years presenting with pain of the right iliac fossa. In patients undergoing surgery, the final diagnosis of acute appendicitis was confirmed by the anatomo-pathological examination while it was negated when the symptoms regressed in the absence of any treatment. Results: Our study included 106 patients. In patients with Alvarado score less than 4, the diagnosis of acute appendicitis was never retained. The best sensitivities and specificities were found in patients with a threshold value of 8 (Alvarado score). Our study demonstrated that Alvarado score can provide immediate benefit in the diagnosis of acute appendicitis based on its good sensitivity (81.25%) and correct positive predictive value (74,28%). The group of patients with a score strictly less than 4 was considered to be low risk. The patients with Alvarado score strictly greater than 6 would require hospitalization either to undergo emergency surgery or to undergo imaging examinations and be monitored. In the group of patients with a score between 4 and 6 (extremes included) there was no diagnostic certainty, hence complementary imaging techniques were essential. Conclusion: In our Emergency Department Alvarado score helps clinicians to streamline patient's management and to give an indication to the diagnosis by limiting the prescription of radiological examinations, the cost of patients' management and the abusive surgical procedures.