Assessment of the Alvarado´s scale in the clinical diagnosis of acute appendicitis

Abstract

Introduction: acute appendicitis is the leading cause of emergency surgery in general surgery. Its diagnosis remains eminently clinical, and there are tools like the Alvarado´s score that allow a better assessment in the accurate diagnosis of the condition. Objective: to evaluate the usefulness of Alvarado´s Score in the clinical diagnosis of acute appendicitis. Material and Methods: an evaluation study of diagnostic tools was carried out, in which an assessment was performed on patients with acute abdominal pain and presumptive diagnosis of acute appendicitis. The Alvarado´s scale was used, by means of which sensitivity, specificity, predictive values, and likelihood ratios were assessed. Results: of all patients (533), appendicitis was confirmed at laparotomy in 90,4%. Best diagnostic values of the disease for the scale values were those higher than 7 (sensitivity 55.4, specificity 96.1) score. The migration of pain was the specific component of higher value for the diagnosis (sensitivity 81.9, specificity 94.1). The test did not allow an accurate differentiation between the score and the possible anatomic-pathological status of the disease. Conclusions: The Alvarado´s scale is a useful tool in the clinical diagnosis of inflammation of the appendix, primarily for scores higher than 7. The migration of pain was the specific item of the score with better diagnostic value. This did not allow discriminating adequately the possible anatomic-pathological status of the condition based on the value of the score.Keywords: appendix, appendicitis, appendectomy, surgery, ultrasonography, pathology, diagnosis, laparoscopy.