Identification of complicated and non-complicated appendicitis: a new alvarado-based scoring system

Ulus Travma Acil Cerrahi Derg. 2024 Feb;30(2):101-106. doi: 10.14744/tjtes.2024.70979.


Background: In the presence of non-complicated appendicitis, treatment typically involves a simple appendectomy and can even be managed medically. However, in cases of complicated appendicitis, surgery becomes more difficult, and the morbidity and mortality rates increase. This study aims to develop a method for recognizing complicated acute appendicitis operatively.

Methods: This retrospective study developed a scoring system based on the Alvarado score. Several variables were scored in this new scoring system, including the Alvarado score, female gender, elevated direct bilirubin, increased appendicitis thickness, and the presence of complications as evidenced by imaging or appendicoliths.

Results: The study included a total of 404 patients with a mean age of 38.50±12.94 years, all operated on for acute appendicitis. Of these, 45.8% were female. Complicated acute appendicitis was present in 25% of the patients. The presence of complicated acute appendicitis was identified with a sensitivity of 86.1% and a specificity of 90.4% in patients who scored 10.5 or above.

Conclusion: It is critical to identify perioperative and postoperative complications, provide appropriate patient counseling, and consider medical treatment when appropriate to diagnose acute complex appendicitis effectively. The new scoring system is an effective method for recognizing acute complicated appendicitis.

MeSH terms

  • Acute Disease
  • Adult
  • Appendectomy
  • Appendicitis* / complications
  • Appendicitis* / diagnosis
  • Appendicitis* / surgery
  • Bilirubin
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Sensitivity and Specificity


  • Bilirubin