_id

683a15f4c782e11e38d1b0c3

id

617

title

Alvarado Score for Acute Appendicitis

full_title

Alvarado Score for Acute Appendicitis

short_title

Alvarado Score

med_description

Predicts likelihood of appendicitis diagnosis.

short_description

Appendicitis diagnosis.

slug

alvarado-score-acute-appendicitis

description

The Alvarado Score for Acute Appendicitis predicts likelihood of appendicitis diagnosis.

keywords

Alvarado Score for Acute Appendicitis, alvarado appy, alvarado appendicitis, alvarado appendicitis calc, alvarado appendicitis score, alvarado appendicitis criteria, alvarado appy calc, alvarado appy r/o, alvarado appy score, alvarado appy rule out, acute appy rule out, acute appendicitis rule out

complaint

[ "Abdominal Pain", "Fever", "Vomiting" ]

formula

Addition of assigned points.

evidence

The Alvarado Score was initially described in 1986 by Dr. Alfredo Alvarado in a retrospective single center study in Philadelphia. In 305 patients aged 4-80 years, eight predictive factors were identified to stratify risk of acute appendicitis. Increasing scores were found to correlate with increasing risk for appendicitis (as determined by final surgical pathology).

In 2007, McKay and colleagues studied a retrospective cohort of 150 patients (age ≥7 years) presenting with abdominal pain, with the aim of stratifying risk specifically for CT scan usage for diagnosis. They found 35.6% sensitivity for appendicitis based on equivocal Alvarado scores (defined as 4-6) compared with 90.4% sensitivity of CT scan in this group, and concluded that patients with equivocal scores would benefit from CT.

Similarly, Coleman et al (2018) conducted a retrospective review in which the Alvarado Score was applied to a cohort of 492 patients (median age 33 years), and found that 20% of patients were in either the high risk group (defined as ≥9 in males and ≥10 in females) or the low risk group (males ≤1, females ≤2), and cumulatively spent over 170 hours awaiting CT that was ultimately unnecessary. They found that scores of 0 or 1 had 0% incidence of acute appendicitis,  and that 100% of males with scores 9-10 and 100% of females with score 10 had acute appendicitis confirmed on surgical pathology.

Pogorelić et al (2015) prospectively studied 311 pediatric patients and applied both the Alvarado score and Pediatric Appendicitis Score (Samuel 2002). Receiver operating characteristic analysis showed similar accuracy between the scores, with AUROC of 0.74 (95% confidence interval 0.662–0.818) for the Alvarado Score and  0.73 (95% CI 0.649–0.811) for the Pediatric Appendicitis Score. The authors concluded that the gestalt of a pediatric surgeon is higher than either scoring system, but the scores may be useful in emergency settings.

measurements

[]

information

As the Alvarado Score is numerical, it has been evaluated for ruling in and ruling out appendicitis.

• Studies ruling out appendicitis (using Alvarado <3-4) have a sensitivity of 96%;

• Studies ruling in appendicitis (using Alvarado >6-7) have a sensitivity of 58-88%, depending on the study and score cutoffs used.

• The 2007 McKay study recommends CT scan for Alvarado 4-6, surgical consultation for Alvarado ≥7, and for Alvarado ≤3, no CT for diagnosing appendicitis, as appendicitis is unlikely.

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/3963537", "text": "Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986 May;15(5):557-64. PMID: 3963537." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/7702329", "text": "Kalan M, Talbot D, Cunliffe WJ, Rich AJ. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Engl. 1994;76(6):418-9." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/12037754", "text": "Samuel M. Pediatric appendicitis score. J Pediatr Surg. 2002;37:872–881." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299622/", "text": "Ohle R, O'Reilly F, O'Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med. 2011;9:139." } ], "Outcomes": [], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/17543650", "text": "McKay R, Shepherd J. The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. Am J Emerg Med. 2007 Jun;25(5):489-93. PMID: 17543650." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/25706925", "text": "Pogorelić Z, Rak S, Mrklić I, Jurić I. Prospective validation of Alvarado score and Pediatric Appendicitis Score for the diagnosis of acute appendicitis in children. Pediatr Emerg Care. 2015;31(3):164-8." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/29521805", "text": "Coleman JJ, Carr BW, Rogers T, et al. The Alvarado score should be used to reduce emergency department length of stay and radiation exposure in select patients with abdominal pain. J Trauma Acute Care Surg. 2018;84(6):946-950." } ], "Validations": [] }

pearls

• More accurate at extremes than for equivocal scores, so it is unclear whether Alvarado scoring is better than gestalt.

• Symptoms may overlap with other diseases; i.e., higher scores are found in patients with non-appendiceal inflammatory conditions, such as diverticulitis or acute pelvic inflammatory disease. It is important to consider the whole clinical picture in making the diagnosis of appendicitis.

• Note that several modifications of the score exist, which may be appropriate in specific settings such as pregnant patients, children, and low-resource settings (without lab availability), but the original Alvarado Score remains the best studied and validated in a general population.

usecase

Patients with suspected acute appendicitis (typically with right lower quadrant pain).

reasons

Acute appendicitis is the most common surgical emergency in the US. Diagnostic accuracy is increased with greater usage of CT scanning; however, CT confers risks and disadvantages such as cost, radiation exposure, and contrast-related complications. The Alvarado Score is a well-established and widely-used clinical decision tool that may help reduce CT usage.

next_advice

Always consider other causes of right lower quadrant pain in your differential diagnosis, including (but not limited to): urologic disease (like kidney stone), ovarian pathology (torsion, tubo-ovarian abscess), and other GI pathology (colitis, diverticulitis).

next_actions

next_management

• Cutoffs differ by study, but one validated stratification assigns the highest risk to scores ≥9 in males or ≥10 in females and lowest risk to scores ≤1 in males or ≤2 in females (Coleman 2018).

• In patients who are high risk, consider treatment without CT imaging, and in patients who are low risk, consider alternative diagnoses.

diseases

[ "Appendicitis" ]

input_schema

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instructions

published

2022-04-21T20:29:44.473Z

purpose

[ "Diagnosis" ]

search_terms

[ "appy", "mantrels" ]

seo

{ "keywords_en": "Alvarado Score for Acute Appendicitis, alvarado appy, alvarado appendicitis, alvarado appendicitis calc, alvarado appendicitis score, alvarado appendicitis criteria, alvarado appy calc, alvarado appy r/o, alvarado appy score, alvarado appy rule out, acute appy rule out, acute appendicitis rule out", "meta_description_en": "The Alvarado Score for Acute Appendicitis predicts likelihood of appendicitis diagnosis." }

specialty

[ "Emergency Medicine", "Pediatrics", "Surgery (General)" ]

departments

[ "Gastrointestinal" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 3984, "short_title_en": "AIR Score", "slug": "appendicitis-inflammatory-response-air-score" }, { "calcId": 3166, "short_title_en": "RIPASA Score", "slug": "ripasa-score-acute-appendicitis" }, { "calcId": 3926, "short_title_en": "Pediatric Appendicitis Score (PAS)", "slug": "pediatric-appendicitis-score-pas" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "gastroenterology" ]

cleaned_use

[ "Patients with suspected acute appendicitis (typically with right lower quadrant pain)." ]

pub

true