Comparative Study of Modified Alvarado Score and Eskelinen Score in Diagnosing Acute Appendicitis

Abstract

Introduction: Despite many advances in diagnosis, diagnosing appendicitis remains difficult. Various diagnostic scoring systems have been developed in an attempt to improve the diagnostic accuracy of acute appendicitis. The study aimed to determine the accuracy of the Modified Alvarado and Eskelinen score in diagnosing acute appendicitis and to correlate the histopathological findings with the severity of acute appendicitis.

Materials and Methods: A prospective study was conducted in TUTH including 84 patients with a clinical diagnosis of acute appendicitis managed surgically for 10 months. Modified Alvarado and Eskelinen Score were calculated and histopathological findings were correlated for predicting the severity of appendicitis.

Results: Out of 84 patients  Modified Alvarado Score had sensitivity and specificity of 67.79% and 32% when the score was taken as 7  and Eskelinen Score had sensitivity and specificity of 70.17% and 29.62% when the score was taken as 55. However, the sensitivity of the Modified Alvarado Score increased to 92.85% and specificity to 14.28% when the cut-off score was taken as 6. Modified  Alvarado Score predicted 67% and 63% of uncomplicated and complicated appendicitis respectively and Eskelinen Score predicted 72% of uncomplicated and 67% of complicated appendicitis when the score was taken as 7 and 55 respectively.

Conclusions: Both Modified Alvarado and Eskelinen Scores have low sensitivity in diagnosing acute appendicitis. With cut off for Modified Alvarado Score taken as 6, sensitivity increased. There was no correlation between the severity of appendicitis with the increase in Modified Alvarado and Eskelinen Score.