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Diagnostic Accuracy of the Modified Alvarado Score and Serum C-reactive Protein in Acute Appendicitis
Atta Ul Aleem Khalid1, Andrew Quarrell1, Anupam Chandran2
1General Surgery, Scunthorpe General Hospital, Scunthorpe, GBR.
Abstract:
Background The Alvarado score is a diagnostic tool to stratify patients on the likelihood of acute appendicitis based on signs, symptoms, and laboratory values. The validity of this score as compared to other diagnostic measures for acute appendicitis is questionable. The current study addresses the use of a modified Alvarado score (MAS) in conjunction with the widely used acute phase reactant biomarker serum C-reactive protein (CRP) for diagnostic accuracy. Objective To determine the diagnostic accuracy in terms of specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) of the combined MAS/CRP keeping histopathological diagnosis of acute appendicitis as a gold standard. Methods This is a cross-sectional validation study carried out in the Department of Surgery, Pakistan Institute of Medical Sciences, Islamabad. A total of 230 patients undergoing appendicectomy for appendicitis were included in the study through non-probability consecutive sampling, with positive histology undetermined. Prior to surgery, the preoperative Alvarado score was calculated and CRP was determined. The appendix removed at surgery was subjected to histopathological examination and on the basis of its report patients were postoperatively diagnosed either as positive or negative for acute appendicitis. Results The mean age of the patients was 22.66±7.48 years. There were 137 (59.6%) males and 93 (40.4%) females. One hundred eighty-three (79.6%) patients had a positive CRP and 47 (20.4%) had a negative CRP. Alvarado scores were calculated and there were 28 (12.1%) patients with a score of ≤ 6, and 202 with a score of 7-9. The appendix removed at surgery was subjected to histopathological examination. One hundred ninety-five (84.7%) patients were positive for acute appendicitis on histopathology and 35 (15.2%) had normal appendix on histopathology. Among the 195 patients with acute appendicitis 178 (91.3%) had positive CRP/MAS and 17 (87.17%) had negative CRP/MAS. Among the 182 patients with positive CRP/MAS; 178 (97.8%) had acute appendicitis and 4 (2.2%) had normal appendix. Among the 48 patients with negative CRP/MAS; 17 (35.4%) had acute appendicitis and 31 (64.3%) had normal appendix. The calculated sensitivity, specificity, PPV, and NPV were 91.2%, 88.5%. 91.8%, and 64.5%, respectively. Conclusion MAS used in combination with CRP is a highly sensitive tool for use in the diagnosis of acute appendicitis and is especially useful in resource-limited healthcare settings and for assistance in decision-making for doctors with less clinical experience.
Insights
The modified Alvarado score combined with C-reactive protein (CRP) demonstrates high sensitivity and specificity for diagnosing acute appendicitis. This combined approach aids clinical decision-making, particularly in resource-limited settings.
Area of Science:
- Medical Diagnostics
- Surgical Pathology
Background:
- The Alvarado score is a clinical tool for assessing appendicitis likelihood.
- Its diagnostic validity compared to other methods is debated.
- This study investigates a modified Alvarado score (MAS) with serum C-reactive protein (CRP) for improved accuracy.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the combined MAS/CRP approach.
- To determine sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
- Histopathological diagnosis serves as the gold standard.
Main Methods:
- A cross-sectional validation study involving 230 patients undergoing appendicectomy.
- Preoperative MAS and CRP levels were recorded.
- Postoperative histopathology confirmed appendicitis diagnosis.
Main Results:
- The combined MAS/CRP showed a sensitivity of 91.2% and specificity of 88.5%.
- Positive predictive value (PPV) was 91.8%, and negative predictive value (NPV) was 64.5%.
- The MAS/CRP combination proved effective in differentiating acute appendicitis.
Conclusions:
- The combination of MAS and CRP is a highly sensitive diagnostic tool for acute appendicitis.
- This approach is valuable in resource-limited healthcare settings.
- It assists clinicians, especially those with less experience, in diagnosis.
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