Role of Rebound Tenderness and Other Parameters in the Evaluation of Acute Appendicitis Using Alvarado Score

Abstract

Objective: To determine the role of rebound tenderness in Alvarado score compared to other parameters in evaluating acute appendicitis.

Study Design: Cross-sectional study.

Place and Duration of the Study: Surgical Emergency Unit, Combined Military Hospital, Rawalpindi, Pakistan, from Jul 2021 to Jan 2022.

Methodology: All the patients aged 18 to 70 years suspected of acute appendicitis were consecutively enrolled. An appendectomy was conducted, and an appendix specimen was sent to confirm the histopathology diagnosis. Rebound tenderness and other Alvarado score parameters were noted. Alvarado score≥7 was labelled as acute appendicitis.

Results: Of 165 patients, the mean age of the patients was 29.09 ±6.63 years. The majority of the patients were males (119, 72.1%). Rebound tenderness was observed in 93 (56.4%) patients, migration of pain in 158 (95.8%), anorexia in 140 (84.8%), nausea/vomiting in 97 (58.8%), right lower quadrant tenderness in 54 (32.7%) cases, elevated temperature in 95 (57.6%), leukocytosis count ≥10 x 103/mm3 in 105 (63.6%), and neutrophil count >75% in 67 (40.6%) patients. A significantly higher association of rebound tenderness was observed with histo pathological findings (p-value <0.001), Alvarado score of >7 (pvalue <0.001), and its other parameters (p-value <0.05). The diagnostic accuracy of rebound tenderness and Alvarado score, taking histopathology as the gold standard, showed a sensitivity of 98.92%.

Conclusion: The study findings have shown that rebound tenderness is the most important sign of acute appendicitis compared with other Alvarado score parameters.