Should Alvarado and Ohmann scores be real indicators for diagnosis of appendicitis and severity of inflammation?

BACKGROUND: Acute appendicitis is one of the most common causes of abdominal pain seen in surgical clinics. Although it can be easily diagnosed, the picture may be confusing, particularly in premenopausal women and the elderly. The present study is an evaluation of 2 of the current scoring systems with respect to accurate diagnosis of the disease and indication of inflammation severity.

METHODS: A total of 105 patients diagnosed with acute appendicitis were included in the study. Subsequent to Alvarado and Ohmann scoring, ultrasonography image was obtained and appendectomy was performed. A unique intraoperative severity scoring system was used to measure severity of inflammation and to compare Alvarado and Ohmann scoring system results to assess accuracy of predictive value for acute appendicitis.

RESULTS: Moderate positive correlation was found between Alvarado score and Ohmann score (r=0.508; p<0.001). Rate of Alvarado score successfully predicting diagnosis of acute appendicitis based on histopathological results was statistically significant (p=0.027), while rate of Ohmann score was not statistically significant (p=0.807). Correlation between both scores and grading of inflammation performed during the operation was weak, but statistical significance was observed between Alvarado scoring system and intraoperative severity scoring (r=0.30; p=0.002). No statistical difference was observed between Ohmann scoring and intraoperative severity scoring (r=0.09; p=0.384).

CONCLUSION: Alvarado score is better able to predict acute appendicitis and provide an idea of severity of inflammation. Ohmann score is more useful to provide guidance and eliminate acute appendicitis from consideration when conditions are more uncertain and obscured.