A prospective diagnostic accuracy study of the Alvarado score in a Croatian hospital - is it time for a final conclusion?

The diagnosis of acute appendicitis still represents a considerable problem for surgeons, with a relatively high rate of false positive findings still present. Thus, the aim of our study was to evaluate the diagnostic accuracy of the Alvarado scoring system based on the prospectively included subjects who presented to the emergency department with suspected acute appendicitis. From June 2018 to May 2020, 176 adult patients examined in the Emergency surgical department of University Hospital Sveti Duh with suspicion of acute appendicitis were prospectively included in the study. The decision on the need for surgery in all patients was made by the same surgeon based only on clinical judgement and remained independent of any diagnostic scoring system. Fifty-eight (33.0%) of them were operated with negative appendectomy rate of 17.2%. Results showed that the surgeon's decision-making process is superior to the Alvarado scoring system (sensitivity and specificity were 96 and 92.06% vs. 84 and 87.30% respectively). The Alvarado scoring system proved to be a worse predictor of the diagnosis of acute appendicitis compared to the assessment of an experienced surgeon and is not an adequate diagnostic tool for confirming the diagnosis. Only in a narrow group of patients in whom, based on the clinical examination, an indication for surgery has already been established, the Alvarado scoring system can potentially be useful in excluding the diagnosis with considerable caution in terms of close follow-up of the patient.