Tardiness or delay in diagnosis of appendicitis, as the most common cause of acute abdomen around the world, is the most important factor in increasing mortality rate in patients. Therefore, early diagnosis is still a challenge for surgeons to be based on signs and symptoms and laboratory tests to make them sure to decide about the surgery.
In a cross-sectional antegrade study, 200 patient who had come with acute abdominal pain to Modarres hospital emergency room, Tehran, Iran, in 12 months were enrolled; the data of 181 patient were complete that was relevant to our study. Alvarado and modified Alvarado scales were used for data collection by the chief resident of surgery. Pathology report was the standard criterion in this survey.
Findings: The accuracy of modified Alvarado score in diagnosis of appendicitis was 81.4% in comparison with 74.0% of Alvarado score. Our modified score with the sensitivity of 88.0% (vs. 67.7%) and the same specificity of 64.4% in detecting normal cases and positive predicting value (PPV) of 66.0% (vs. 41.9%) in diagnosis of acute appendicitis and positive predicting value of 87.3% (vs. 84.1%) in cases of score of more than of 6 was a better score compare to Alvarado score.
Adding abdominal pain, male gender, and qualitative C-reactive protein (CRP) to Alvarado score was resulted in obtaining a higher accuracy in the diagnosis of acute appendicitis.

Various scoring systems have been devised to aid diagnosis of acute appendicitis. The main objective of this study was finding the accuracy of modified Alvarado score in prediction of acute appendicitis. The registries of cases with appendectomy, who had been admitted to a referral medical center in the capital of Iran from February 2000 to March 2004, were studied. Sensitivity and specificity of modified Alvarado scoring and clinical diagnostic system used in our center were calculated. ROC curve analysis demonstrated increasing chance of acute appendicitis by increasing of the modified Alvarado score (P = 0.001), but it was neither sensitive nor specific (sensitivity, 55%; specificity, 59%). Diagnosis based on surgeons'' decision was more sensitive than Alvarado scoring (sensitivity 93-95% in different age groups). Diagnosis of acute appendicitis based on surgeons'' decision is more helpful than modified Alvarado score.

The aim of the current study was to investigate whether the usage of three diagnostic methods of acute appendicitis which are Alvarado score, C- reactive protein (CRP) levels and ultrasound (US) in combination improves diagnostic accuracy significantly.
Patients and Data were analyzed in 254 patients with suspected appendicitis who had a sonographic examination and a CRP value. The patients were classified into four groups according to both Alvarado score and US findings. US results, Alvarado score, and CRP levels were compared.
The most specific test among three diagnostic methods was sonography. Combination of an Alvarado score higher or equal to 5, a high CRP level (≥ 0.8) and a sonographic examination as appendicitis with visualization of an inflamed or perforated appendix was more specific than US alone. An Alvarado score higher or equal to 5 (86.2%) was found to be the most sensitive criteria.
Using Alvarado score, US and CRP levels in combination provides us to confirm or rule out acute appendicitis safely.

Acute appendicitis is the most common emergency surgery; thus, its diagnosis requires high accuracy. This study aimed to determine the agreement between clinical and paraclinical diagnoses in patients with acute appendicitis.

This descriptive study was performed on patients referred to Shahid Beheshti Hospital in Yasouj with suspicion of acute appendicitis in 2018. After considering the inclusion criteria, the files of 200 patients were included in the study by purposive sampling. Age, sex, main problem, symptoms, clinical signs, white blood cell count, and ultrasonography and pathology report were extracted from the patients' files, and the Modified Alvarado Score was calculated based on their information.

The mean age of the patients was 24.3±13.2 years, and the most common symptoms were anorexia and abdominal tenderness. The Modified Alvarado Score was  4-6 in 126 (63%) and 7 or higher (37%) in 74 patients. In addition, 182 patients (91%) had a positive pathology for appendicitis. There was a statistically significant relationship (p=0.03) between Modified Alvarado Score and pathology; however, there was no statistically significant relationship (p=0.43) between Modified Alvarado Score and ultrasonography. There was a significant relationship (p=0.0001) between pathology and ultrasonography. The ultrasonography sensitivity was 37.1%, specificity was 87.2%, positive predictive value was 96.8%, and negative predictive value was 11.7%.

There is an agreement between the Modified Alvarado Score and ultrasonography in diagnosing acute appendicitis with the pathology as the gold standard in the diagnosis of appendicitis; however, there is no agreement between the Modified Alvarado Score and ultrasonography.

 Acute appendicitis is one of the most common abdominal emergencies worldwide. The Modified Alvarado score is 9-point scoring system for diagnosis of appendicitis based on clinical signs and symptoms and differential leucocyte count. Previous studies have suggested that Alvarado score alone is inadequate as a diagnostic test, but it has been advocated as a means of select ing patients who should undergo imaging.To evaluate the effectiveness of Modified Alvarado Score and Focused Appendicitis Ultrasonography in predicting acute appendicitis and to compare the accuracy of two modalities alone and combined.

The study was performed in the postgraduate department of General Surgery, Government Medical College, Jammu over a period of one year from November 2021 to October 2022. 100 patients who were under the age of 18 years irrespective of their gender suspected to have appendicitis were included in the study.

 There were 64 males and 36 females. The majority of patients were in the age group of 12-15 years (51%). Modified Alvarado Score alone has sensitivity of 84.51%, specificity of 33.33%, Positive predictive value of 83.53%, negative predictive value of 34.98% and accuracy of 74.27%. Focused ultrasonography alone has sensitivity of 100% and accuracy of 80.00%, positive predictive value of 80%. The combined sensitivity of MAS+ focused appendicitis ultrasonography is 98.80 % with specificity of 11.76%, positive predictive value of 81.75%, negative predictive value of 70.94% and accuracy of 81.39%. The percentage of negative appendectomies was 14.45%.

  The sensitivity of Modified Alvarado Score is less than the sensitivity of Focused Appendicitis Ultrasonography. When both investigations combined together, their sensitivity, specificity, positive value, negative predictive value and the accuracy improves the diagnosis of acute appendicitis.

Diagnosis of acute appendicitis is one of the challenges that surgeons face in the emergency ward. Although Alvarado score has been recommended in the diagnosis of acute appendicitis, this criterion has some limitations in terms of age, sex, and race. The aim of this study was to evaluate the effectiveness of Alvarado score in the diagnosis of acute appendicitis based on the age and gender. In this cross-sectional study, 407 patients who underwent operation with the preoperative diagnosis of acute appendicitis from June 2008 to August 2009 were included in the study. The patients’ data were recorded by the investigators. The data were compared by parametric tests. The sensitivity and specificity were determined by the optimal cut-off point on ROC curve using MedCalc software version 10.2.0.0. The optimal cut-off point for women was lower than men (6 and 7, respectively). The rate of negative appendectomy in the group with Alvarado scores 9 and 10 was 11.8%, while the negative appendectomy rate in the other two groups with Alvarado scores 7 and 8 and 5 and 6 were 29.9% and 52.8%, respectively. The diagnostic value of Alvarado score of 8 and less in physical examination is lower than the abdominal tenderness exam alone. Also, the cut-off point for the diagnosis of acute appendicitis in women should be considered lower than that in men. On the other hand, the cut-off point in adolescents and children is higher than adults

Acute appendicitis is one of the commonest surgical emergencies. There are different scoring systems in use to diagnose the appendicitis. The aim of this study was to assess the diagnostic accuracy of Alvarado scoring system in clinical practice for acute appendicitis. This medical diagnostic-test study was performed from January 2009 till September 2010 in surgery clinic of Farabi hospital, Mashhad. For all patients, Alvarado score has been determinate preoperatively; and intraoperative finding and histopatological examination of the removed appendix confirmed diagnosis. The study was conducted among 150 patients (63% male, 37% female). Specificity was 68 %, whereas sensitivity was 74.8%. The negative appendectomy rate was 5.7% with score 7 or more Alvarado score. The positive predictive value was 98.1%. The accuracy rate was 74%. The cut-off score was 7. In the diagnosis of acute appendicitis Alvarado score has a high diagnostic value (74%). Alvarado score increases the diagnostic certainty of clinical examination in diagnosis of acute appendicitis.

Acute appendicitis is the most common emergency operation in the world. Considering negative appendectomy, it is necessary to use accurate diagnostic methods to lower the rate. This study evaluated the sensitivity and specificity of abdominal sonography in comparison to clinical Alvarado criteria in patients with suspected appendicitis. 370 patients with suspected appendicitis selected from Imam Reza Hospital in Kermanshah, Western Iran. Clinical Alvarado score was calculated for each patient and then all of them followed by abdominal sonography and abdominal operation. Necessary data such as age, sex, weight and duration of symptoms were recorded. Diagnostic accuracy of sonography and Alvarado criteria was calculated in compare to pathology as a gold standard. Reducible rate of negative appendectomies with sonography was also calculated. Sensitivity and specificity of sonography was 98.3% and 76.4% respectively. Positive Predictive Value and Negative Predictive Value of sonography was 95.7% and 89.4% respectively. Negative appendectomy rate was 14.9% (55 patients), which 42 patients (76%) had negative sonography. 11.4% of all operated patients could avoided according to sonography resulta. 10.9% of patients with Alvarado score of 9-10, 14% with score of 7-8 and 19.4% with score of 5-6 had negative appendectomy respectively. Abdominal sonography prior to operation can avoid unnecessary operation in patients with suspected appendicitis. Clinical Alvarado criteria can still be a good tool for screening of patients with abdominal pain.

Acute appendicitis is the major cause of abdominal pain which indicates urgent surgery. Commonly, it is diagnosed through clinical signs and symptoms and blood test. This study aimed to assess the  accuracy of acute appendicitis diagnosis through signs and symptoms, Alvarado score system, and ultrasonography method. This was a cross-sectional study. Medical profiles of 696 patients with abdominal pain suspected of acute appendicitis referred to Shahid Faghihi hospital were reviewed from June to October 2016. A checklist was used for data collection. The gold standard for diagnosis of acute appendicitis was patient’s pathology report. For signs and symptoms, Alvarado score system and ultrasonography method sensitivity, specificity, positive and negative predictive value, and the Youden’s index were calculated based on true positive and true negative values. Among 696 patients suspected of acute appendicitis, 371 (53.3%) were men and 325 (46.7%) women. The mean age for women and men was 30.14+11.49  and 30.53+11.61 years, respectively. Sensitivity and specificity for ultrasonography and Alvarado score system were 68.1% and 78.9%, 76.1%, and 59.9%, respectively. The areas under roc curve and the Youden’s index for ultrasonography and Alvarado score system were 0.73, 0.47, and 0.71, 0.55, respectively.   The results showed that ultrasonography and Alvarado score system were effective pre-surgical diagnostic tests for patients suspected of acute appendicitis.

Introduction & For evaluation of laboratory data in the diagnosis of suspected acute appendicitis, many studies has been performed. In addition to White Blood Cell count (WBC) new laboratory variables such as C - reactive protein (CRP) and procalcitonin (PCT) have been introduced to help for a more definite evaluation. But, the findings are different and uncertain. The sensitivity and specificity of these variables are important for better diagnosis and in this study were assessed. A prospective cross-sectional study was done, which included 100 suspected patients with acute appendicitis who were admitted to a university hospital. After clinical evaluation and physical examination, WBC, CRP and PCT were determined. Decision for operation was made according to Alvarado scaling. After appendectomy and according to the pathologist report the patients were divided into two groups, having acute appendicitis or normal appendix. The sensitivity and specificity of these tests were compared between the two groups. In the 100 cases involved, 71 patients were male and 29 were female. The mean age of patients was 28.01±12.68 year. After operation, it was established in pathologic evaluation that 83 patients had acute appendicitis (AA), and 17 patients had normal appendix (NA). As far as WBC (P= 0.001) and Alvarado Scaling (P= 0.006) were showed. There was a significant difference between the two groups. But there was no significant for CRP (P= 0.025) and PCT (P= 0.042). Sensitivity of WBC, CRP and PCT were 85.5%, 92.77% and 55.42% respectively. Also, the specificity of WBC, CRP and PCT was 41.17%, 11.76% and 29.41% respectively. In the diagnosis of acute appendicitis use of symptoms and signs and laboratory data is helpful, although CRP and PCT can also help us in diagnosis in difficult situation.