JLUMHS MAY - AUGUST 2008 93 Original Article ABSTRACT OBJECTIVE: Acute appendicitis is one of the commonest surgical emergency. There are differ- ent scoring systems in use to diagnose the appendicitis. Aim of this study was to document the diagnostic accuracy by application of Alvarado Scoring System in clinical practice for acute ap- pendicitis. DESIGN: Descriptive case series. SETTING: Surgical Unit-II, Liaquat University Hospital Hyderabad, Sindh – Pakistan; from Janu- ary 2003 to September 2004. METHODS: All the patients with suspected appendicitis were admitted in the ward. A profroma was designed and relevant findings were documented. These were observed regarding the in- crease or decrease in severity of symptoms and hence the change in the initial score according to Alvarado Scoring System was documented at the time of admission. Decision regarding sur- gical intervention was made on the basis of change in the score. RESULTS: A total of 227 patients with clinical features suggesting acute appendicitis was ad- mitted in the ward. Among them, 150 (66.07%) were males and 77 (33.92%) were females. Age ranged from 10-62 years. Main symptoms at presentation included pain in right iliac fossa 67.8%, fever 66.9% and nausea and vomiting 49.7%. Thirty two patients were received with Alva- rado Score of 1-4 and three out of them required surgery. Thirty five patients were in the score of 5, twenty three out of them required surgery. One hundred sixty patients were in the score of 6 and above, all of them required surgery. Out of 185 patients who underwent surgery, 178 pa- tients had appendicitis. The negative appendicectomy rate was 3.78%. CONCLUSION: It is concluded that according to Alvarado the patients with score up to 4 proba- bly do not require surgery and among the patients with score up to 5, most of them need sur- gery while the patients with the score of 6 and above will require surgery. KEY WORDS: Appendicitis. Appendicectomy. Alvarado scoring system. INTRODUCTION Acute abdominal pain is one of the commonest surgi- cal emergencies. Appendicitis is one of the common- est causes of abdominal pain requiring emergency surgery. Often, it is difficult to reach the proper diagno- sis. There may not be classical symptoms and signs of appendicitis. Different clinical signs and symptoms always mimic the diagnosis of acute appendicitis, as there are number of causes leading to pain in right iliac fossa particularly in female patients. Purpose of different scoring systems for diagnosis of the appendi- citis is to facilitate the surgeon and to avert negative appendicectomy. 1,2 At present, other scoring systems are also in use, like Ramirez and Dues. Alvarado scor- ing system is based on history, physical examination, few laboratory investigations and is easy to apply in comparison to other systems. Decision making in cases of acute appendicitis may be difficult, radiologi- cal investigations are not of much help, though ultra- sound, laparoscopy and C.T scan may be helpful. Di- agnostic accuracy regarding appendicitis also de- pends on the experience of surgeon, yet the need for supportive measures is always there. Aim of this study was to evaluate the diagnostic accuracy of Alvarado scoring system in our setup which is simple to apply 3 , and is of much help to junior surgeons. Definitive diag- nosis can however be reached at surgery and after histopathology. Diagnostic Accuracy of Alvarado Scoring System in Acute Appendicitis Abdul Ghani Soomro, Faisal Ghani Siddiqui, Arshad Hussain Abro, Shahnawaz Abro, Noshad Ahmed Shaikh and Abdul Sattar Memon