The comparison of the effectiveness of tomography and Alvarado scoring system in patients who underwent surgery with the diagnosis of appendicitis

Abstract

Objective: The aim of this study is to compare the effectiveness of computed tomography and Alvarado scoring system in the diagnosis of acute appendicitis in patients who underwent appendectomy with the preliminary diagnosis of acute appendicitis.
Material and Methods: One hundred and one patients who underwent appendectomy with the diagnosis of acute appendicitis between January and December 2011 were included in the study. Alvarado scores were calculated, and abdominal tomography scans were obtained for each patient before surgery. Patients with Alvarado score ≥7 were considered to have appendicitis while patients with a score <7 were considered not to have appendicitis. Patients were classified into two groups based on the presence of appendicitis findings on abdominal tomography. Histopathological examination of the appendices was performed following appendectomy. All patients were classified into groups according to pathology results, Alvarado score and tomography findings. The effectiveness of Alvarado score and tomography were compared using the McNemar test.
Results: Sixty patients (59.4%) were male and 41 (40.6%) were female, with a mean age of 32 years (5-85 years). The rate of negative appendectomy was 3.9%. In 78 patients (77.3%) the Alvarado score was ≥7, while 23 patients (22.7%) had Alvarado scores <7. The presence of appendicitis was determined by histopathology in 22 out of 23 patients whose Alvarado score was <7. Tomography indicated appendicitis in 97 patients (95.9%) whereas four patients (4.1%) exhibited no signs of appendicitis by tomography. However, histopathological evaluation indicated the presence of appendicitis in those four patients as well.
Conclusion: The study results imply that tomography is a more effective means of diagnosing acute appendicitis as compared to the Alvarado scoring system.

Ethics committee approval was received for this study from the ethics committee of Fatih University School of Medicine.

Additional informed consent was not taken because the diagnosis process and the intervention were routine for appendicitis.

Externally peer-reviewed.

Concept - A.Ö., Z.Y.; Design - A.Ö.; Supervision - Ö.F.A., A.Ö.; Funding - A.Ö., Z.Y.; Materials - A.Ö., T.A.; Data Collection and/or Processing - Z.Y., T.A.; Analysis and/or Interpretation - A.Ö., Ö.F.A.; Literature Review - T.A.; Writer - A.Ö., Z.Y.; Critical Review - Ö.F.A., A.Ö.

No conflict of interest was declared by the authors.

The authors declared that this study has received no financial support.

We would like to thank Dr. Fatma Fidan and Doç. Dr. Levent Sarı for his help with the statistical analyses of our data.