Introduction The Alvarado scale has been used as a scoring tool to predict the likelihood of acute appendicitis, but has not been validated in the female population. Female gender confers an independent risk for higher negative appendicectomy due to diagnostic confusion with gynaecological pathology.
Method We performed a prospective study of surgical referrals of female subjects of reproductive age triaged as “suspected appendicitis”. We calculated the Alvarado score for each presentation and compared the score with the respective histological findings of those who underwent an appendicectomy. Negative appendicectomy was defined by histological diagnosis only.
Results One hundred female subjects were investigated for suspected appendicitis, of which 46% (n = 46) underwent a laparoscopic appendicectomy. 60% (n = 27) of those who had an appendicectomy had histologically proven acute appendicitis and 40% (n = 17) had a normal appendix. 88% (n = 15) of the negative appendicectomies had an Alvarado score of ≤5, as compared to 37% (n = 10) of those with acute appendicitis. Likewise, 63% (n = 17) of those with acute appendicitis had a score of ≥6, as compared to 12% (n = 2) of those who did not have acute appendicitis. 54% (n = 54) did not undergo surgery, of which 80% (n = 43) scored ≤5.
Overall, in those who had an appendicectomy, a cut off score of ≤5 was suggestive of a normal appendix, whereas a score of ≥6 suggested acute appendicitis.
Conclusion Scores of ≤5 can be interpreted as a predictive factor to rule out acute appendicitis. When used in conjunction with clinical judgment, the application of the score in the diagnostic workup can contribute towards greater diagnostic accuracy and subsequently reduce the frequency of negative appendicectomy in females.
Disclosure of interest None Declared.
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