A prospective evaluation of the combined use of the modified Alvarado score with selective laparoscopy in adult females in the management of suspected appendicitis

Background: A diagnostic scoring system such as the modified Alvarado score , combined with selective laparoscopy in adult females, can be used in the assessment of acute abdominal pain suggestive of appendicitis. Method: A total of 84 consecutive patients presenting to our surgical team with suspected appendicitis were assessed prospectively using the modified Alvarado score. The definitive management of this study group was instigate d according to a set algorithm based on the score. The algorithm included t he use of diagnostic laparoscopy in adult female patients with scores sugge stive of appendicitis. A negative appendicectomy rate was obtained from tho se undergoing appendicectomy using this approach and compared to that obtai ned from the 97 patients that had undergone appendicectomy under the care o f the other surgical teams in our unit during the study period. Results: The rate of negative appendicectomy in the study group was 0% comp ared to 18% in the control group (P < 0.05); 10% of adult female women had negative diagnostic laparoscopies for appendicitis thus saving this group a n unnecessary appendicectomy. This was achieved without an increase in tota l in-patient stay. Conclusion: An algorithm combining the modified Alvarado score with selecti ve laparoscopy is recommended for widespread use in the management of suspe cted acute appendicitis.