Usefulness of the Alvarado Scale in Patients with Suspected Acute Appendicitis in Relation to Imaging Results
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Abstract
Background: Multiple studies demonstrate that the Alvarado Score is less effective than other studies in predicting the incidence of patients with suspected acute appendicitis. It does not distinguish between ages and does not suggest a clinical stage of the disease. However, its use is still current in our unit and in most hospitals in our country.
General Objective: To identify the utility of the Alvarado Score in patients with suspected acute appendicitis in relation to imaging results.
Materials and Methods: Descriptive, observational, cross-sectional, retrospective study, which was carried out with 62 records of patients with suspected acute appendicitis and who were requested imaging studies at the Regional General Hospital 1 of Orizaba, Veracruz with the suspected diagnosis of Acute Appendicitis during the period from December 1, 2017 to November 30, 2022. Patients of any age group and both sexes who came to the emergency service with pain in the right iliac fossa and classified with the Alvarado scale that met the selection criteria were included. This study was conducted from March 1 to September 30, 2023. Data analysis included descriptive statistics for qualitative variables using frequencies and percentages, as well as measures of dispersion. For quantitative variables, such as mean and standard deviation, the Fisher exact test was used between variables with two categories based on the nature of the categorical variables. SPSS 23 and GraphPad Prism 8 software were used.
Resources and infrastructure: those of the institution, the patients, and the researcher.
Group experience: There is a master's degree in science and a radiologist with experience in ultrasound and CT interpretation. A resident physician who will carry out the activities of the research project.
Results: The female sex predominated with a frequency of 40 patients (56.33%) with a mean age of 28.80 years, standard deviation +/- 19.36 (95% CI 22.61-34.99), of the male sex a frequency of 31 patients (43.66%) was observed with a mean age of 28.16 years, standard deviation +/- 17.69, the time of onset of symptoms: 35 patients (49.3%) began with symptoms at 24 hours, followed by 15 patients (21.1%) at 12 hours, 11 patients (15.5%) at 72 hours, 7 patients reported onset of symptoms at 48 hours (9.9%). The relationship between the Alvarado scale and imaging studies was identified using Fisher's exact test. The P value was 0.8791, which is considered statistically insignificant.
Conclusion: The Alvarado score has proven to be a useful, simple, noninvasive, and rapid tool for guiding the diagnosis of acute appendicitis. However, due to its low specificity, the use of imaging studies is always recommended to confirm suspected diagnoses.
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