Use and relevance of modified alvarado scoring system in diagnosis of acute appendicitis: a cross sectional study from West Bengal, India


  • Malay K. Barman Department of General Surgery, North Bengal Medical College, Darjeeling, West Bengal, India
  • Mahua Chanak Department of Anthropology, Vidyasagar University, West Bengal, India
  • Kaustav Das Department of Anthropology, Bangabasi College, West Bengal, India
  • Koel Mukherjee Department of Anthropology, Haldia Government College, West Bengal, India



Acute appendicitis, Histopathology, Modified Alvarado Scoring System


Background: For successful management of acute appendicitis, early diagnosis and intervention is needed. Incorrect diagnosis may allow significantly increased morbidity and mortality. Several studies across the globe shows that Modified Alvarado Scoring System (MASS) does not need high end instrument and can be done in emergency situation for accessing acute appendicitis and reducing the chances of unnecessary surgery. To access the efficacy of MASS for diagnosis of acute appendicitis in remote areas with primary health care facilities, present study was done at Siliguri of Darjeeling district of West Bengal which was 580 km distant from state capital (Kolkata).

Methods: A cross sectional study over a period of 16 months was conducted among the patients admitted at North Bengal Medical College and Hospital suspected to have acute appendicitis. The diagnosis was confirmed by histopathological examination. Written consent was obtained from the patients before commencement of the study. MASS was applied to the patients and the results were compared with histopathological findings. Appropriate statistical analysis has been done by SPSS (version 16.0).

Results: A total of 75 patients (44 males and 31 females) were considered. The sensitivity and specificity of MASS in this study were 75.86% (71.43% for males and 80% for females) and 82.61% (80% for males and 87.5% for females) respectively. Study revealed statistically significant (p<0.000) association between Histopathological report and MASS.

Conclusions: To reduce the chances of negative appendectomy and for better diagnosis of appendicitis, MASS may be more useful at primary health care centres those are located in remote areas as it was very simple, easy and cost effective.


Puylaert JB. Acute appendicitis: US evaluation using graded compression. Radiol. 1986;158(2):355-60.

Pearson RH. Ultrasonography for diagnosing the appendicitis. BMJ. 1988;297:309-10.

Ramachandra P, Sudhir M, Sathyanarayana BA. Evaluation of modified alvarado score in preoperative diagnosis of acute appendicitis. JEMDS. 2013;2(46):9019-29.

Nema P, Jain AK. A clinical comparative study of different scoring systems in acute appendicitis. Int Surg J. 2016;3:184-8.

Kanumba ES, Mabula JB, Rambau P, Chalya PL. Modified Alvarado scoring system as a diagnostic tool for acute appendicitis at Bugando Medical Centre, Mwanza, Tanzania. BMC Surg. 2011;11(1):4.

Peterson MC, Holbrook JH, Von Hales D, Smith NL, Staker LV. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. Western J Med. 1992;156(2):163.

Jade R, Muddebihal UM, Narayan N. Modified alvarado score and its application in the diagnosis of acute appendicitis. IJCMR. 2016;3(5):1398-40.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557-64.

Douglas CD, Macpherson NE, Davidson PM. Randomized controlled trial of Ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. BMJ. 2000;321:919-22.

Gupta M, Virdi VS, Agnihotri L, Mandial V. Evaluation of Modified Alvarado Score and Ultrasonography for the Diagnosis of Acute Appendicitis. IJSR. 2016;5(3):2166-68.

Peyvasteh M, Askarpour S, Javaherizadeh H, Besharati S. Modified Alvarado score in children with diagnosis of appendicitis. ABCD. Arq Brasil Cirurgia Dig (São Paulo). 2017;30(1):51-2.

Shuaib A, Shuaib A, Fakhra Z, Marafi B, Alsharaf K, Behbehani A. Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis. World J Emerg Med. 2017;8(4):276-80.

Kalan M, Rich AJ, Talbot DR, Canlitie WJ. Evaluation of modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Eng. 1994; 76:418-19.

Bhattacharjee PK, Chowdhary T, Roy D. Prospective evaluation of modified Alvarado score for diagnosis of acute appendicitis. JIMA. 2002; 100(8):310-12.

Subotić AM, Sijacki AD, Dugalić VD, Antić AA, Vuković GM, Vukojević VS, et al. Evaluation of Alvarado score in the diagnosis of acute appendicitis. Acta Chir Iugosl. 2008;55(1):55-61.

Patel V, Kela M, Prasad S, Gautam AS, Gupta M. Evaluation of modified Alvarado scoring system in diagnosis of acute appendicitis - a prospective study Evaluation of modified Alvarado scoring system in diagnosis of acute appendicitis - a prospective study. Int Surg J. 2016;3(2):621-25.

Talukder DB, Siddiq AZ. Modified Alvarado scoring system in the diagnosis of acute appendicitis. J Armed Forces Med Coll Bangladesh. 2009;5(1):18-20.

Macklin CP, Radcliffe GS, Merei JM, Stringer MD. A prospective evaluation of the modified Alvarado scores for acute appendicitis in children. Ann R Coll Surg Eng.1997;79:203-5.

Nasiri S, Mohebbi F, Sodagari N, Hedayat A. Diagnostic values of ultrasound and the Modified Alvarado Scoring System in acute appendicitis. Int J Emerg Med. 2012;5(1):26.

Al-Hashemy AM, Seleem MI. Appraisal of the modified Alvarado Score for acute appendicits in adults. Saudi Med J. 2004;25(9):1229-31.

Hajong R, Anand M, Hajong D, Singh LK, Sharma G, Naku N. Role of Modified Alvarado Score in the Diagnosis of Acute Appendicitis. IJARS. 2016;5(4):SO01-4.

Gilmore OJA, Jones D, Ynag Q. Appendicitis and mimicking conditions. Lancet. 1975;11:421-4.

Barman M, Das K, Mukherjee K.A Study on comparision of diagnostic efficiency between Modified Alvarado score and graded compression ultrasonography in the case of acute appendicitis. IJCRR. 2018;10(9):22-6.

Fares A. Summer Appendicities. Ann Med Health Sci Res. 2014;4(1):18-21.

Llves I, Fagerstrom A, Herzig KH, Juvonen P, Pekka M, Paajanen H. 2014. Seasonal variation of Acute appendicitis and nonspecific abdominal pain in Finland. World J Gastroenterol. 2014;20(14):4037-42.






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