Revista Colombiana de Cirugía
versión impresa ISSN 2011-7582
SANABRIA, Álvaro et al. Validation of the Alvarado diagnostic scale in patients with abdominal pain suggesting appendicitis at a second level health care center. rev. colomb. cir. [online]. 2010, vol.25, n.3, pp. 195-201. ISSN 2011-7582.
Introduction. Acute appendicitis is the most common entity encountered by surgeons. There is still an indiscriminate use diagnostic methods with undue costs and no diminution in the number of negative appendectomies. The aim of this study was to evaluate the diagnostic capacity of the Alvarado scale in patients with suspected appendicitis and to determine its usefulness in the discrimination and definition of diagnostic conducts. Material and methods. A prospective study of diagnostic tests and methods was designed in order to evaluate the Alvarado scale in patients with uncertain diagnosis of appendicitis. The method of reference was the pathology report. The levels of risk (low, intermediate, high) were defined according to the scale values and the cost of resources was simulated. Results. Seventy one patients (37% men) were included; 66.7% had appendicitis. The rate of negative appendectomies was 22.6% and the rate of negative laparotomies was 17.7%. The cost of the resources utilized without using the scale was Colombian Pesos $ 113,217 million (1USDollar = 2,900 Col Pesos $) with a negative appendectomy rate of 22.6%. The proposed scheme showed an expense of Col Pesos $ 101,582 million, with a negative appendectomy rate of 8.0%. Discussion. The Alvarado scale permits the classification of patients with suspected appendicitis in groups: a low-risk group (0-4 points) with a probability of appendicitis of 7.7%; an intermediate risk-risk group (5-7 points) with probability of appendicitis of 57.6%; and a high risk group (8-10 points) with a probability of appendicitis of 90.6%. Application of the scale diminished costs by 10% and reduced the rate on negative appendectomies by 8%. Its use is reproducible and offers the advantage a more rational use of resources and diminution in the number of unnecessary operations.
Palabras llave : appendicitis; diagnosis; sensitivity and specificity; Alvarado score.