Ingrid G Malaluan
St. Luke’s Medical Center, Philippines
Title: An assessment of the Alvarado scoring system in the diagnosis of acute appendicitis among the pediatric patients at a tertiary care medical center
Biography
Biography: Ingrid G Malaluan
Abstract
Objectives: To review the demographics and clinical course of admitted patients with possible acute appendicitis (AA), determine the Alvarado score of operated patients and correlate with histopathology results, correlate the Alvarado score and ancillary procedure results, describe the alternative diagnoses of patients initially considered to have AA and to determine the negative appendectomy rate. Design: It is a retrospective & descriptive study. Setting: St. Luke’s Medical Center, Philippines, a tertiary, private institution. Participants: 82 admitted pediatric patients from the ER (January 2012 to June 2013), assessed using the Alvarado score and suspected to have AA were included. Patients with imaging confirmed diagnosis or those who were already treated conservatively upon arrival at the ER, patients with incomplete documentation or who were discharged against medical advice were excluded. Main Outcome Measure: Histopathology findings among post-appendectomy patients and alternative diagnoses among those who were not operated on. Results: There was a significant difference in the number of patients with scores 1-4, 5-6, and 7-10 with and without appendicitis, thus a significant correlation between the Alvarado score and the diagnosis of AA existed. Among patients with AA, there is an increasing trend of making accurate diagnosis with an increasing score group. Conversely, an opposite trend is observed among those without AA. The negative appendectomy rate was 10.6%. Conclusion: The Alvarado scoring system is a practical non-invasive diagnostic procedure that is simple, fast, safe and reliable. It categorizes patients for discharge and for admission for further evaluation and management. Patients with score 7-10 should undergo appendectomy to avoid complications. Patients with score 5-6 should be admitted for observation and further evaluation. Score 1-4 can be discharged with an advice to seek consult as indicated.
