Does Alvarado Score Reduce the Need for Ultrasonography in the Diagnosis of Acute Appendicitis?

Abstract

Aims: We aimed to evaluate the correlation between Alvarado scoring and ultrasonographic findings in the diagnosis of acute appendicitis and its role in reduction of the rate of negative appendectomy. Methods: A total of 2772 patients operated between January 2010 and September 2016 with the presumed diagnosis of acute appendicitis were retrospectively evaluated. Patients with appendicitis detected in histopathologic examination were assessed as Group 1, and those with no appendicitis detected were assessed as Group 2. Results: The rate of negative appendectomy was 5.3%. Alvarado score was ≥7 in 2226 and <7 in 399 patients in Group 1. Alvarado score was ≥7 in 92 and < 7 in 55 patients in Group 2 (P < 0.0001). Among the patients with acute appendicitis identified in histopathologic examination, USG revealed acute appendicitis in 1804 and no acute appendicitis in 422 of the patients with an Alvarado score >7. Among the patients without acute appendicitis in histopathologic examination, USG revealed acute appendicitis in 74 and no acute appendicitis in 18 of the patients with an Alvarado score >7, while acute appendicitis was detected in USG in 29 and was not detected in 26 of the patients with an Alvarado score <7. Conclusion: While possibility of correct diagnosis is high in patients with an Alvarado score ≥7, the diagnosis should not be ruled out in patients with a low Alvarado score. Instead of using alone, the use of Alvarado scoring and ultrasonography together could reduce the rate of negative appendectomy and increase specificity.