Turkish Journal of Surgery

Turkish Journal of Surgery

ISSN: 2564-6850
e-ISSN: 2564-7032


Zeki Özsoy, Erdinç Yenidoğan

Department of General Surgery, Gaziosmanpaşa University School of Medicine, Tokat, Turkey

Keywords: Acute appendicitis, Alvarado Score, cut-off value


Objective: In this study, we aimed to show the effectiveness of Alvarado score and its components to predict the correct diagnosis of acute appendicitis and to find an optimum cut-off value for Alvarado score.
Material and Methods: The patients who underwent surgical operation between January 2011 and January 2012 with the suspicion of acute appendicitis were included in the study. Their demographic and clinical features and histopathological results were retrieved from the medical records. They were divided into three groups according to their Alvarado scores. With the use of “receiver operating characteristic” curve analysis, the optimum cut-off value needed to make a correct diagnosis of acute appendicitis was determined.
Results: In all, 156 patients were included into the study. The mean age was 31.41±13.27 years. Histopathologically, acute appendicitis was detected in 125 (80.1%) patients, and negative appendectomy was found in 31 patients (19.8%). Mean Alvarado score was 6.44±1.49. There was a significant correlation between negative appendectomy and low Alvarado score (p<0.001). The main component of Alvarado score that makes the difference was rebound. Fever higher than 37.3°C, rebound, loss of appetite, and existence of shifting pain were statistically differential components (p=0.042, p<0.001, p=0.045, p<0.001, respectively). The rate of correct diagnosis of acute appendicitis was maximum in group 3 (100%) and minimum in group 1 (21.7%). Optimum cut-off value for Alvarado score was 7.
Conclusion: Patients with an Alvarado score of over 7 can be taken into surgical operation without the need of imaging methods.

This study was presented at the 48th Congress of the European Society for Surgical Research, 29 May-1 June 2013, İstanbul, Turkey.

Cite this paper as: Özsoy Z, Yenidoğan E. Evaluation of the Alvarado scoring system in the management of acute appendicitis. Turk J Surg 2017; 33: 200-204.

Ethics Committee Approval

Authors declared that the research was conducted according to the principles of the World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects” (amended in October 2013).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - Z.Ö., E.Y.; Design - Z.Ö., E.Y.; Supervision - Z.Ö., E.Y.; Resource - Z.Ö.; Materials -Z.Ö.; Data Collection and/or Processing - Z.Ö.; Analysis and/or Interpretation - Z.Ö.; Literature Search - Z.Ö.; Writing Manuscript -Z.Ö.; Critical Reviews - E.Y.

Conflict of Interest

No conflict of interest was declared by the authors.

Financial Disclosure

The authors declared that this study has received no financial support.


Due to his contributions to the study we thank Abdullah Özgür Yeniova from, Gaziosmanpaşa University School of Medicine, Gastroenterology Department.