Background and Objectives: Appendicitis is a common surgical emergency. The patients with equivocal signs can present a diagnostic challenge. Early diagnosis and intervention is mandatory for prevention of complications. On the other hand negative appendicectomy should be avoided as much as possible. The aim is to evaluate the role of the modified Alvarado scoring system in early diagnosis of acute appendicitis.Methods: During a period of 6 months from 1st February to 31st July 2008; 250 patients with right iliac fossa pain were admitted and observed in Emergency Hospital in Erbil. The age of the patients was ranged between 13-70 years (mean 22 years ). The male to female ratio was 3:2. They were prospectively evaluated on admission using modified Alvarado scoring system to determine whether or not they had acute appendicitis. The results were correlated with the operative and histopathological findings.Results: After first scoring; 179 (72%) patients were admitted and 71 (28%) patients were discharged. Rescoring by modified Alvarado scoring system was done after 6 hours from admission, only 162 (91%) patients were operated on , and the rest 17 (9%) patients were discharged. During operation we found that 142 cases (87.5%) had really acute appendicitis. Overall the modified Alvarado scoring system showed sensitivity of (93%) for [8-9] scores and (39%) for [1-7] scores. .Conclusions: The modified Alvarado scoring system is accurate in early diagnosis of acute appendicitis . Patients with 8-9 scores should be operated on immediately without hesitation. Patients with score 5-7 must be admitted and scored frequently. Score 1-4 can be discharged unless otherwise indicated.

Modified Alvarado scoring system --- Acute appendicitis --- Appendicectomy