TESTING ACCURACY OF PRE-OPERATIVE ALVARADO SCORE BASED MANAGEMENT ALGORITHM IN DIAGNOSING ACUTE APPENDICITIS
Sapna Gupta*, Ashraf Rasheed
General Surgery, Royal Gwent Hospital, Cardiff, United Kingdom
BACKGROUND & AIM: Appendectomy is most common emergency general surgical procedure with a constant negative appendicitis rate. The aim of the study is to test the possibility of navigating towards a most accurate pre-operative diagnosis of acute appendicitis utilising a pre-operative Alvarado score-based management algorithm.
METHOD: A prospective data collection of patients who are 15 years old and above and referred with suspected appendicitis from family doctors or the emergency room was collected over one month period in a busy UK district general hospital. The doctors completing the score sheets for Alvarado score and senior doctors managing the patients were not informed of the purpose for the data collection and allowed to manage the patients in the usual manner. We then followed the patients’ management pathway recording the operative and histological findings. We studied the rate of concordance with our proposed algorithm; then compared the actual management Vs what would have been the management if the proposed algorithm was not followed looking particularly at instances of when unnecessary surgery could have been avoided or indeed delayed management could have resulted.
RESULTS: A total of 59 patients were identified, male to female ratio was 1:1.26 (26males and 33 females). Median age of data set was 31years. The management algorithm was followed in 53.8% of males and 42.20% females. Investigations requested without following algorithm was 26.9% (7/26) in males and 39.3% (13/33) in females. Most common group of patients where avoidable investigations were requested was in females with score of 0-3, where 9 out of 12 females had investigation which did not change in management were discharged after negative investigation.
Total number of appendicectomies performed over one month was 27; 6/27 (22%) were negative for appendicitis i.e. unacceptably high and 4/6 (67%) were females with Alvarado score of 4-8 with negative investigations i.e. won’t have undergone surgery if the algorithm was followed which would have reduced the negative appendicectomy rate to 7%.
CONCLUSION:
The negative appendectomy rate of 22% in this cohort is unacceptably high but following the proposed evidence-based algorithm could have reduced it to 7% with all obvious benefits.
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