Appraisal of the modified Alvarado Score for acute appendicits in adults

OBJECTIVE: Decision making in cases of acute appendicitis may be difficult specially for junior surgeons. Radiological investigations do not appear to be helpful. In some studies, the Modified Alvarado Scoring System (MASS) was helpful in minimizing unnecessary appendicectomies. The aim this study was to evaluate the sensitivity of MASS in the diagnosis of acute appendicitis in adults.

METHODS: All adult patients aged 16-years and above who were admitted with a provisional diagnosis of acute appendicitis between January 2001 and January 2002, into the Armed Forces Hospitals, Southern Region, Khamis Mushayt, Kingdom of Saudi Arabia were prospectively entered into this study. The study included 125 patients between the ages of 16 and 76-years. They were prospectively evaluated on admission using the Modified Alvarado Score (MAS) to determine whether or not they had acute appendicitis. The MASS was correlated with the operative and histopathological findings.

RESULTS: One hundred and 10 patients (88%) had appendicectomies of which 30 patients (27.3%) had normal appendices on histopathology examination. Overall the MAS system showed a sensitivity of 53.8% and a specificity of 80%. For males, the sensitivity was 56.4% and the specificity was 100%. For females, the sensitivity and specificity were 48% and 62.5%.

CONCLUSION: From the results, the MASS is not sufficiently sensitive adopted as a method of diagnosing of acute appendicitis in adults in our environment. Further, requirements may be needed to improve its sensitivity and specificity.