MALACCA
MODIFIED ALVARADO SCORE IN THE DIAGNOSIS OF ACUTE APPENDICITIS.
I.Yahya,
I.Huzaimi,
L.M.Wong
Department
of Surgery, Malacca Hospital, Jalan Mufti
Khalil, Malacca, Malaysia.
Objectives:
This study
was performed to evaluate the accuracy of Malacca Modified Alvarado score (MMAS) as an alternative to conventional method
in diagnosing acute appendicitis. It also study the sensitivity of MMAS in different genders and age groups, sensitivity of
various groups of score and it safety when being subjected to low scoring groups and incidence of perforations.
Methods:
A prospective study of all patients admitted for Acute Appendicitis assessed by
Malacca Modified Alvarado score from September 2002 till March 2003 in Malacca
Hospital.. Patient will be scored with MMAS and grouped into 3 different
categories, Score (1-4), (5-7) and (8-10). Results are interpreted by pathologist and classified as inflamed or non inflamed.
.
Results:
A total of 454 cases representing patient with probable diagnosis of acute appendicitis
are involved in the study. 204 cases were female, 156 cases male and 90 cases children (age 6-12). Of 163 (36.2%) patient
with score 1-4, 11 of them were operated due to persistent pain and only 3 were confirmed appendicitis. A total of 47 (16.3%)
out of 287 operated cases were found to be non-inflammed. The distributions were 5.3% in children, 10.7% adult male and 27.1%
adult female. A total of 134(94.4%) of 142 cases in score 8-10 have inflamed appendix. 24 of 27 perforated cases belong to
score 8 and above.
Conclusions:
MMAS has less parameter compared to original Alvarado or other modified Alvarado
scores. The removal of 1 parameter (anorexia or presence of acetone in urine)
and replacement of rebound tenderness with Right Iliac fossa rigidity has made the scoring system more practical and easily
followed by most physicians. The significant reduction in the overall number of non inflamed appendix and the high accuracy
rate (>98%) in excluding appendicitis has made it safe and relatively accurate diagnostic tools especially in children
and adult male. This study also showed that observing patient in certain group does not increase morbidity (perforations)
but it helps in reducing the number of unnecessary appendicectomy. Though female have the highest number of non inflamed appendix,
it is relatively low compared to historical results and perhaps in future there
is a role of diagnostic laparoscopic in improving further the diagnosis of acute appendicitis.
(Published and presented
at Annual Malaysian College of Surgeon Meeting at Penang Malaysia, July 2005)
