BC 01. Comparison of Alvarado-Score And Clinical Judgement in the Diagnosis of Acute Appendicitis – Prospective, Randomized Trial

---

E. Mán, A Varga, G. Lázár

Chair(s): Mustafa Cikirikcioglu, Frank Dor, René Tolba, David J. Hackam, Cliff Shearman, Modise Koto

13:30 - 13:40h at Erszebet Room (A)

Categories: Emergency Surgery, ESSR Best Clinical Research Paper

Session: ESSR Best Clinical Research Paper

---

Invited discussant: Osman Yuksel, Attila Szijártó, Lázár György, Gokhan Yagci, Mihály Boros, Thomas Hubert

Background
The Alvarado-score is a clinical scoring system used in the diagnosis of suspected appendicitis. It contains 8 clinical signs and two laboratory values with a total 10 points.

Material and Methods
In our prospective, randomized trial we involved patients attending at our outpatient department with suspected appendicitis. They were divided into two groups. (A and B). The management of patients was based on the Alvarado-score in group A and on decision of the chief surgeon in group B. We compared the correlation of diagnosis and pathological finding in each group, and we tried to refine the score with regression analyasis by weightening each criteria. We used SPSS 20 program for statistical analysis.

Result
A number of 233 patients was included in our study (gropup A n=95, group B n=138). The number of negative appendectomies was 8 in group A and 5 in group B (p=0.084). The specificity of the score was 88,91% vs. 94,8% of the clinical judgement. The score-pathological finding rank correlation was 0.523, the ROC analysis value was 0.837. We also specified the score with regression analysis, with the calculated new score system the ROC analysis result was better AUC=0.849. When further refining the score by opting in the result of US investigation the AUC became 0.893.

Conclusion
The Alvarado-score is a reliable tool in the diagnosis of acute appendicitis in the emergency room, but still traditional clinical judgement is better. We found the new score made by logistic regression more reliable.