Optimal Alvarado score and predictive factors of negative appendectomy rate
Keywords:
Alvarado score, negative appendectomy rate, the optimal cut-off point for surgical decision-makingAbstract
Objective : To find the optimal Alvarado score and evaluate predictive factors of negative appendectomy rate.
Material and Methods : Four-hundred-five acute appendicitis patients, who was assessed by Alvarado score were enrolled in this retrospective study. The demographic data, presenting symptoms, investigations, operative findings, pathology results, postoperative complications and length of stay were collected from medical records from 1 March 2015 – 30 September 2020. The primary outcome was the optimal Alvarado score from area under the curve (AUC) by receiver operating characteristic analysis (ROC). The secondary outcome was predictive factors of negative appendectomy rate by multivariate logistic regression analysis with MedCalc Version 20.015 และ SPSS version 21.
Results : The optimal Alvarado score is 8 (Sensitivity 54.47%, Specificity 70.21%). The multivariate analysis revealed female gender (p-value = .019) and diarrhea (p-value = .035) increased negative appendectomy rate.
Conclusions : The optimal Alvarado score is 8 (Sensitivity 54.47%, Specificity 70.21%). The negative appendectomy rate decreased from overall 11.6% to 6.7% when the Alvarado score cut-off value at 8 was applied. The positive predictive factors of negative appendectomy rate female gender and diarrhea. When the Alvarado score was less than 8. The surgical treatment should be considered if migratory pain, leukocytosis and neutrophil shift were presented. On the other hand, the imaging investigation should be considered if female gender and diarrhea were presented.
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