Correlation between Alvarado score and histopathology in appendicitis – A pilot study

Abstract

Introduction: Alvarado scoring system is an easy, clinical tool in the preoperative evaluation of acute
appendicitis. Many a times, the diagnosis is made by the clinical examination along with ultrasonography
and computed tomography scan. Alvarado score (AS) supposedly improves the diagnostic accuracy and
consequently reduces negative exploration.
Aims: The aim of this study was to explore the possibility of a correlation of preoperative Alvarado scoring
with histological evidence.
Materials and Methods: This pilot study was carried out to evaluate histopathological (HP) correlation
with AS, in 100 patients admitted in the department of surgery of a rural medical college. HP grades were
first constructed, and then, the score was compared so as examine the correlation if any. A Histopathology
report (HPR) grade of 5 was taken as normal appendix.
Results: In a sample size of 100, there were a maximum of 46 patients with AS score 5 and 6 and 44 patients
with HP Grade 4. Using receiver operating characteristic curve, the cutoff for the score was 5 with a sensitivity
of 58.24% and specificity of 33.33%. The negative appendicectomy rate was 9%.
Conclusion: The AS score correlates poorly with the HP findings.