Comparative study of management of acute appendicitis with special consideration of “Alvarado Score”

Background: Acute appendicitis is a common still with appreciable morbidity and occasional mortality which may possibly be related to failure to make early diagnosis. As a result, surgeons have learned over the decades to accept a high negative laparotomy rate in an attempt to avoid mortality. This has stimulated formulation of simple scoring systems to aid in early diagnosis which are in vague for a decade but hardly been evaluated thoroughly. The aim was to evaluate existing scoring system that is Alvarado score, and to study the clinical, laboratory and imaging modalities used in diagnosis of this disease and its management. Materials and methods: This review was based on the study of 50 selected cases of acute appendicitis treated in our institution by random sampling. All the patients were observed clinically for operation and not by scoring. Scoring was and added exercise for these patient evaluation. They were correlated with USG, operative findings and histopathological examination. Results: 86% patients had right iliac fossa (RIF) pain which when combined with vomiting was highly suggestive of acute appendicitis and resulted in higher scores. 86% patients had tenderness in RIF which was present in higher scores of appendicitis and highly suggestive of appendicitis when combined with rebound tenderness. 80% patients had leukocytosis >10000/cu.mm. That was more common in higher score. In my study of 50 cases of clinically acute appendicitis proved that Alvarado score 9-10 that was 22 patients out of 50 with 100% accuracy and scores 7-8 that was 19 patient, 11 patients had acute appendicitis. Thus the score increases sensitivity of accuracy increases. Score below 6 patients can be treated with conservative treatment without major complications and thereby decreases negative appendicectomy rate. Conclusion: Alvarado score is useful in specific diagnosis of acute appendicitis. It is better in terms of lower rate of negative appendicectomy and thereby decreasing morbidity and mortality. There is no much added advantage of USG over clinical scoring system in this study.