From the Guidelines
The Alvarado score is the most widely used and recommended scoring system for diagnosing appendicitis, as it has been shown to be sufficiently sensitive to exclude acute appendicitis, especially with a cutoff score of less than 5, as indicated by the most recent and highest quality study 1. The Alvarado score assigns points based on eight clinical and laboratory findings: migration of pain to the right lower quadrant (1 point), anorexia (1 point), nausea/vomiting (1 point), right lower quadrant tenderness (2 points), rebound tenderness (1 point), elevated temperature ≥37.3°C (1 point), leukocytosis >10,000/mm³ (2 points), and neutrophil shift to the left >75% (1 point). Some key points to consider when using the Alvarado score include:
- A score of 7-10 indicates a high probability of appendicitis
- A score of 5-6 suggests possible appendicitis requiring further imaging
- Scores below 5 make appendicitis unlikely Other scoring systems, such as the RIPASA score, may be more accurate in specific populations, such as Asian populations, but the Alvarado score remains the most widely used and recommended system, as supported by the study 1. It is essential to note that while the Alvarado score is a useful tool for diagnosing appendicitis, it should be used as an adjunct to clinical judgment rather than as an absolute diagnostic tool, as emphasized in the study 1. In elderly patients, the Alvarado score can be used to exclude appendicitis, but it may not be sufficient for diagnosing it, as suggested by the study 1. Overall, the Alvarado score is a valuable tool for clinicians to make timely decisions about whether to proceed with surgery, order additional imaging, or observe patients, thereby reducing unnecessary surgeries while preventing complications from delayed diagnosis, as indicated by the study 1.
From the Research
Scoring Systems for Diagnosis of Appendicitis
The diagnosis of appendicitis can be facilitated by various scoring systems, including:
- Alvarado score: a widely used scoring system that takes into account symptoms, signs, and laboratory results to predict the likelihood of appendicitis 2, 3, 4
- RIPASA score: a scoring system designed for the Asian population, which has been shown to be more accurate than the Alvarado score in some studies 3
- Appendicitis Inflammatory Response (AIR) score: a scoring system that includes objective variables reflecting the inflammatory response, which has been shown to outperform the Alvarado score in some studies 5
- Modified Alvarado Scoring System (MASS): a modified version of the Alvarado score, which has been shown to be improved by the addition of new parameters such as tenesmus 6
Characteristics of Scoring Systems
The characteristics of these scoring systems are:
- Alvarado score: consists of 10 points, with a score of 5 or less indicating a low likelihood of appendicitis, and a score of 7 or higher indicating a high likelihood of appendicitis 2, 4
- RIPASA score: consists of 15 points, with a score of 7.5 or higher indicating a high likelihood of appendicitis 3
- AIR score: consists of 8 variables, with a high score indicating a high likelihood of appendicitis 5
- MASS: consists of the original Alvarado score criteria, with the addition of new parameters such as tenesmus 6
Performance of Scoring Systems
The performance of these scoring systems has been evaluated in various studies, with results showing:
- Alvarado score: sensitivity and specificity ranging from 58.9% to 96.2% and 67% to 100%, respectively 2, 3, 4
- RIPASA score: sensitivity and specificity of 96.2% and 90.5%, respectively 3
- AIR score: area under the receiver operating characteristic curve (AUC) of 0.97 for advanced appendicitis and 0.93 for all appendicitis 5
- MASS: accuracy rate of 80%, with improved sensitivity and specificity compared to the original Alvarado score 6