Editorial comment on: ‘Evaluation of the Alvarado scoring system in the management of acute appendicitis’

Dear Editor,

We readthe article titled “Evaluation of the Alvarado scoring system in the management of acute appendicitis” by Özsoy et al. (1) published in 2017 issue (2017; 33(3): 200–204.) of the Turkish Journal of Surgery with great interest.

Acute appendicitis (AA) is probably the most common surgical emergency throughout the world. It is important to make an accurate diagnosis of AA in order to reduce the negative appendectomy rate. Therefore, taking a good medical history, physical examination, imaging tests and scoring systems have a great value.

Özsoy et al. (1) aimed to show the value of Alvarado Score (AS) in AA and to suggest a “management algorithm” according to AS in their study. After reviewing this paper, we would like to emphasizeseveral issues. First of all, it is not understood whether the study design was prospective or retrospective. If this is a prospective study, it will be appropriate to define the randomization method between the groups. The authors divided patients into 3 groups according to their Alvarado score: AS 1–4 (Group 1), AS 5–7 (Group 2) andAS ≥8 (Group 3). However, when we reviewed the literature, we found that the groups were generally divided as AS 1–4, AS 5–6 and AS 7–10 (2). The authors should explain to readers how they have classified these patients. In addition, the reasons why 14.7% of the patients in Group1 underwent surgery despite the literature recommendation of discharge instead of surgery for this group should be clarified by the authors (2). Although the authors’ main purpose was to suggest a “management algorithm” in light of their results, we could not find an algorithm in this paper. We believe that writing a “management algorithm” will be quite beneficial for the readers.

The efficiency of AS parameters for the diagnosis was given in Table 3. The reliabilityof AS in the diagnosis for AAhas already been shown in various studies (2, 3). It is also controversial that only 3 of those parameters were found significant in this study. In our opinion, creating a new table comparing Group 1 with Group 3 and Group 2 with Group 3 by determining a cut-off value will contribute more to the literature than the existing table.

Furthermore, the authors recommended that imaging tests should not be used in patients with AS> 7 in the conclusion part, whereas the correlation between imaging tests and AS was not evaluated in the study and they did not even mention which imaging methods had beenperformed in the materials-methods section. We believe that it is crucial to explain how they have reached such a conclusion.