الفهرس 
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Abstract
This study was aiming to evaluate the sensitivity and specificity of Alvarado score combined with ultrasound abdomen and pelvis in cases of right iliac fossa pain with suspected acute appendicitis.
100 patients complaining of right iliac fossa pain with suspected acute appendicitis admitted to the Department of Surgery at Alexandria Main University Hospital during 2013 were studied prospectively where the demographic information, physical examination, laboratory data, Alvarado score, sonography report and histopathological reports of patients were gathered.
Ultrasound results were classified into either positive for appendicitis or negative for appendicitis or equivocal.
- Negative for appendicitis:
When appendix is not seen or seen normal or other pathology identified
- Equivocal:
Appendix is not seen but abnormal amount of free fluid with thickened, dilated, or non-peristaltic bowel in the region of caecum.
- Positive for appendicitis:
• Non-compressible, non-peristaltic blind ended tubular structure with outer diameter is ≥6 mms.
• Increased echogenicity of the surrounding fat.
• The presence of appendicolith (intra-luminal echogenic focus with posterior shadowing).
• Peri-appendicular collection denoting perforation or abscess formation.
• Hyper vascularization of the appendix when seen by color Doppler.
The studied patients were 57 female (57%) and 43 male (43%). Their ages ranged from 14 to 48 years, with a mean of 25.93 ± 8.18 years.
Pathological assessment confirmed acute appendicitis in 63 patients out of 71 patients operated for appendectomy (taking into consideration other 4 patients operated for gynecological diseases), where the remaining 25 patients were not operated and followed up for 48 hours then in the outpatient clinic after one month.
Assessing Alvarado score alone in diagnosis of appendicitis we found that:
- Using cutoff 5 we had sensitivity of 100% in excluding appendicitis.
- Using cutoff 6 we had a sensitivity of 63.5%, specificity of 81.1% and accuracy of 73%.
- Using cutoff 7 we had a sensitivity of 76.2%, specificity of 59.5% and accuracy of 70%.