title: Alvarado score for the acute appendicitis in a provincial hospital.
abstract: OBJECTIVE
  To assess the accuracy of Alvarado Score in predicting acute appendicitis in Chachoengsao Hospital.
  
  
  METHODS
  The prospective study involved 1, 000 patients with suspected acute appendicitis. It was carried out between April 2008 and March 2010. The patients were given specific scores according to variables of Alvarado Scoring System. The signs, symptoms, laboratory values and pathology reports of each patient were collected and evaluated. The diagnosis was confirmed by operative findings and histopathological examination of specimens. The sensitivity, specificity, positive and negative predictive values and receiver operator characteristic (ROC) curves of each indicator were also calculated.
  
  
  RESULTS
  Out of total 1,000 patients (407 males, 593 females), 838 underwent surgery (352 males, 486 females) and specimens of 715 patients (313 males, 402 females) were confirmed by histopathological examination, thus giving negative appendectomy rate of 14.7% (11.08% males, 17.28% females). The overall sensitivity of Alvarado Score was 87.41% and the specificity was 74.39%, while the positive predictive value was 83.7%. The area under the curve was 0.74.
  
  
  CONCLUSIONS
  Though the diagnosis of acute appendicitis remains mainly clinical evaluation, Alvarado Score can be recommended as a helpful tool for the admission criteria and further management in order to reduce unnecessary admission, morbidity and mortality, length of stay, and cost of treatment.
authors: Division of Surgery, Chachoengsao Hospital, Chachoengsao, Thailand. chairoek_li@hotmail.com
authors: Chairoek
authors: C
authors: Limpawattanasiri