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2025, Vol. 7, Issue 2, Part C
The role of Alvarado score in predicting acute appendicitis and its severity in correlation to histopathology: A prospective observational study
Author(s): Hassan Khalil Melek
Abstract:
Background: Acute appendicitis (AA) remains the most common non-obstetric surgical emergency globally, imposing a significant burden on healthcare systems, particularly in low- and middle-income countries (LMICs) where access to advanced imaging is limited. While the Alvarado score (AS) is widely used for diagnostic triage, its capacity to predict not only the presence but also the pathophysiological severity of appendiceal inflammation as confirmed by histopathology remains inadequately explored.
Objective: This study aimed to: (1) quantify the diagnostic accuracy of the AS using histopathology as the gold standard; (2) establish the correlation between preoperative AS and postoperative histopathological severity; (3) identify optimal AS thresholds for predicting complicated appendicitis; and (4) evaluate the negative appendectomy rate across AS strata.
Methods: A prospective, single-center, observational cohort study was conducted at Al-Zahraa Teaching Hospital, Iraq, from January 2023 to June 2024. 320 adult patients with suspected AA underwent appendectomy within 24 hours of admission. AS was calculated prospectively by blinded residents. Histopathological grading (Grade 0-4: Normal to Perforated) was performed by two blinded, board-certified pathologists (Cohen’s ? = 0.91). Statistical analysis included ROC curves, Spearman’s correlation, and multivariate logistic regression.
Results: Histopathology confirmed AA in 294 patients (91.9%). At a cutoff of ?7, AS demonstrated 92.1% sensitivity, 85.4% specificity, and an AUC of 0.931. A strong positive correlation existed between AS and histopathological grade (Spearman’s ? = 0.782; p<0.001). Multivariate analysis revealed AS ?9 as the strongest independent predictor of complicated appendicitis (adjusted OR = 6.82; p<0.001). 89.6% of patients with AS ?9 had gangrenous or perforated appendicitis. The negative appendectomy rate was 8.1%, with 84.6% occurring in the AS 5-6 group.
Conclusion: The Alvarado score is not only a highly accurate diagnostic tool but also a powerful prognostic indicator of disease severity. An AS ?7 reliably indicates the need for surgery, while an AS ?9 should trigger protocols for managing complicated disease. Integrating AS into clinical algorithms can optimize resource use, reduce unnecessary surgeries, and improve outcomes, especially in resource-limited settings.
DOI: 10.22271/27081494.2025.v7.i2c.214
Pages: 144-153 | Views: 126 | Downloads: 71
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How to cite this article:
Hassan Khalil Melek. The role of Alvarado score in predicting acute appendicitis and its severity in correlation to histopathology: A prospective observational study. Int J Case Rep Surg 2025;7(2):144-153. DOI: 10.22271/27081494.2025.v7.i2c.214
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