Validation of the Modified Alvarado Score in Patients Attending A&E Unit With Suspected Appendicitis – Prospective Clinical Study

Abstract BackgroundThe aim of our prospective study was to confirm the validity, diagnostic accuracy of the modified Alvarado score developed in the Department of Surgery, University of Szeged.Methods138 patients were enrolled in our study between 01 January 2019 and 01 January 2020. The patient’s modified Alvarado score was calculated in the Emergency Department before surgical consultation and decision of further therapy. The score was validated based on the final histology finding of the removed appendix. Additionally, potential correlation was examined between the frequency of drain usage, hospital stay, antibiotic use and the severity of the inflammation. ResultsComparing the scores with the histological findings, specificity of the modified Alvarado score was 84.78%, its sensitivity was 97.83% (with cutoff value of 5.5). Spearman's rank correlation (0.796) and ROC analysis (area under the curve 0.968) confirmed that the modified Alvarado score has an excellent predictive value in the diagnosis of acute appendicitis. Based on the result of the Fisher's exact test, cross tabulation and Spearman’s rank correlation correlation was found between the severity of the inflammation determined by the histology finding, the selected antibiotic and the duration of the antibiotic therapy, the average duration of hospitalization and drain insertion. ConclusionsBased on the results of our study, predictive value of the new, modified score system is excellent, using this score system is safe in the differential diagnosis of acute appendicitis as an aid for non-surgical consultants in emergency care. This new score system may decrease the number of unnecessary surgical consultations, decrease waiting time of the patients and some unnecessary examinations can be avoided. Trial RegistrationValidation of the modified Alvarado score in patients presenting in the Emergency Department with right lower abdominal complaints, ethical license number: 248/2018/SZTE, date of registration: 2018.11.04., name of ethics committee: SZTE SZAKK Regionális és Intézményi Humán Orvosbiológiai Kutatásetikai Bizottság- Clinical Research Coordination Office of the University of Szeged