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.. Objectives: The objective of this study was to compare the efficacy of Clinical Evaluation and modified Alvarado scoring system in diagnosing acute appendicitis. Study Design: Cross sectional study. Place and Duration of Study: This study was conducted at Surgical Unit III of Civil Hospital Karachi from May 2010 to October 2010. Methodology: This study consisted of eighty patients. Patients were divided in two groups. Group A for complete clinical evaluation comprising of 40 patients and Group B for modified Alvarado scoring system comprising of 40 patients. Inclusion criteria were all patients presenting with RIF pain, nausea, vomiting, fever and/or anorexia, diagnosed as having acute appendicitis preoperatively and undergoing emergency appendectomy during this period, age >12 years and both gender. Exclusion criteria included not willing for surgery, General anesthesia problem, pregnant female patients and those who did not give written consent. Results: A total of 80 patients were included in the study, placed alternatively into two groups of 40 patients each with majority being male (n = 61, 76.3%). The mean age was 22.46 years. The positive predictive value for patients of Group A was 92.5% while for Group B was 77.5%. When diagnostic accuracy was compared on the basis of Gender for the two groups, the positive predictive value for male patients of Group A and B was 90.09% and 89.28% respectively, but for females the positive predictive value of Group A and B was 100% and 50% respectively. Conclusion: We conclude that modified Alvarado score can be used safely and effectively in diagnosing acute appendicitis in adult males especially as the score increases from seven to nine.

ACUTE APPENDICITIS; EFFICACY OF COMPLETE CLINICAL EVALUATION AND MODIFIED ALVARADO SCORING SYSTEM IN DIAGNOSE