EFFECT OF PREHOSPITAL ANALGESIA ON THE DIAGNOSTIC ACCURACY OF THE ALVARADO SCORE FOR COMPLICATED ACUTE APPENDICITIS IN A PERUVIAN EMERGENCY HOSPITAL

Chavarry-Delgado H.E.; Roque-Quezada J.C.; Virú-Flores H.M.; Barturen-Julca V.A.; Jesús Alvarado-Villafane J.P.; Xiomi Rojas-Catacora M.D.R.; Vega-Vega R.R. · Revista de la Facultad de Medicina Humana (2025) · DOI: 10.25176/rfmh.v25i3.7706

Resumen

Introduction: Complicated acute appendicitis represents an abdominal emergency in which timely detection is essential to prevent adverse outcomes. Objective: To estimate the effect of prehospital analgesia on the diagnostic accuracy of the Alvarado score for identifying complicated acute appendicitis. Methods: An observational, analytical, retrospective, diagnostic accuracy study was conducted at the Hospital de Emergencias José Casimiro Ulloa during the period 2020-2024. A total of 596 adult patients with confirmed acute appendicitis were included, equally distributed into two groups: without prehospital analgesia and with prehospital analgesia. The diagnostic performance of the Alvarado score was assessed using Receiver Operating Characteristic (ROC) curves and compared between groups with the DeLong test. Results: The Alvarado score showed an overall area under the curve (AUC) of 0.823 (p<0.05), with better performance in patients without analgesia (AUC=0.859) compared with those who received it (AUC=0.790). The optimal cutoff point was eight in both groups. Sensitivity was 79.9% in the group without analgesia and 74.1% in the group with analgesia. Similarly, the prevalence ratio (PR) was higher among patients without analgesia (PR=3.04) compared with those who received it (PR=2.88). Conclusion: Prehospital analgesia reduces the diagnostic accuracy of the Alvarado score for detecting complicated acute appendicitis and should be considered as a modifying factor during the initial clinical evaluation. © It is an open access article, distributed under the terms of the Creative Commons License: Creative Commons Attribution 4.0 International, CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/ non-commercial use, distribution and reproduction in any medium, provided that the original work is duly cited.

Instituciones: Universidad Privada San Juan Bautista; Universidad Privada Norbert Wiener