Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 295
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Advertise | Login 
Year : 2011  |  Volume : 5  |  Issue : 1  |  Page : 6-11

Evaluation of the modified Alvarado score incorporating the C-reactive protein in the patients with suspected acute appendicitis

1 Department of Surgery, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
2 Department of Surgery, SMHS Hospital, Srinagar, Jammu and Kashmir, India
3 Department of Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, India

Correspondence Address:
Sheikh Muzamil Shafi
Lal Bazar, Srinagar, Jammu and Kashmir
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0331-3131.84220

Rights and Permissions

Background : Acute appendicitis is perhaps the most common surgically correctable cause of acute abdominal pain and its diagnosis remains difficult in many instances. Some of the signs and symptoms can be subtle to both the clinician and the patient and may not be present in all the instances. Arriving at the correct diagnosis is essential; however a delay in diagnosis may allow progression to perforation and significantly increase the morbidity and mortality. Materials and Methods : This study was a prospective study and comprised 200 patients admitted with suspected acute appendicitis. The patients were selected unbiased from all age groups of either sex and were evaluated on the basis of predetermined proforma. Subsequent to hospital admission, the preoperative modified Alvarado score (MAS) was determined and C-reactive protein levels (CRP) were estimated. The results of the MAS and preoperative CRP levels were compared with the histopathology of the removed appendix. Results : Among all the patients studied, 12, 52, and 136 patients had preoperative MAS of <5, 5-6, and 7-9 respectively. One hundred sixty six patients had CRP level raised. A total of 158 patients were histopathologically positive for apendicitis. The sensitivity and specificity of MAS in patients with a score of 5-6 were 58% and 13.5% respectively. In patients with a score of 7-9, MAS had sensitivity and specificity of 93% and 50% respectively. We found 93% sensitivity and 85% specificity of CRP for the diagnosis of acute appendicitis. When combined with CRP, the sensitivity and specificity of MAS in patients with score of 7-9 were raised to 98% and 54% respectively. Moreover, the sensitivity of MAS in patients with a score of 5-6 was raised significantly from 58% to 93%. Conclusion : We concluded that MAS in combination with the CRP levels is very helpful in the diagnosis of acute appendicitis especially in patients with modified a Alvarado scores in the middle range, who are categorized as "equivocal" for appendicitis by the Alvarado score.

Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)

 Article Access Statistics
    PDF Downloaded808    
    Comments [Add]    
    Cited by others 3    

Recommend this journal