What is the Alvarado score (Acute Appendicitis scoring system)?

From the Guidelines

The Alvarado score is a clinical scoring system used to assess the likelihood of acute appendicitis in patients presenting with abdominal pain, ranging from 0-10 points and including eight clinical and laboratory findings. The score combines patient symptoms, physical examination results, and laboratory values to assign a score from 0 to 10, with higher scores associated with a higher likelihood of appendicitis and lower scores with a lower likelihood of appendicitis 1. The eight clinical and laboratory findings included in the Alvarado score are:

• 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 cells/mm³ (2 points)
• Neutrophil shift to the left >75% (1 point)

A score of 0-4 suggests appendicitis is unlikely, 5-6 indicates possible appendicitis requiring further imaging or observation, and 7-10 strongly suggests appendicitis, often warranting surgical consultation 1. However, it's essential to note that the Alvarado score should be used as a clinical aid rather than a definitive diagnostic tool, as no scoring system is perfect, and clinical judgment remains essential when evaluating patients with suspected appendicitis. Some studies have found that a low Alvarado score does not reliably exclude appendicitis or the need for CT, particularly in patients in extremes of age 1. Therefore, the Alvarado score should be used in conjunction with clinical judgment and other diagnostic tools to ensure accurate diagnosis and appropriate management of patients with suspected appendicitis.

From the Research

Overview of the Alvarado Score

The Alvarado score is a clinical scoring system used to predict the likelihood of acute appendicitis based on signs, symptoms, and laboratory data 2, 3, 4, 5, 6.

Components of the Alvarado Score

Although the exact components of the Alvarado score are not specified in the provided studies, it is mentioned that the score is based on clinically predictive values, including signs, symptoms, and laboratory data 2.

Diagnostic Utility of the Alvarado Score

The Alvarado score has been shown to be an effective tool for the timely differential diagnosis of acute appendicitis, with a high sensitivity and specificity for predicting the likelihood of appendicitis 2, 4.

• The score can help risk-stratify patients with suspected appendicitis and potentially decrease the use of CT imaging in patients with certain Alvarado scores 3.
• A score of 7 or higher is associated with a high incidence of acute appendicitis, with a sensitivity of 77% and specificity of 100% 6.
• A score of 3 or lower has a high sensitivity for not having appendicitis, with a sensitivity of 96.2% and specificity of 67% 6.

Comparison with Clinical Judgment

The Alvarado score has been compared to clinical judgment in the diagnosis of acute appendicitis, with clinical judgment showing better specificity and sensitivity than the Alvarado score 5.

• However, the score is still a useful diagnostic aid, especially for young colleagues, and can be refined to include new criteria such as ultrasound investigation 5.

Recommendations for Use

The Alvarado score can be used to guide the decision to perform computed tomography (CT) scans in patients with suspected appendicitis 6.

• Patients with Alvarado scores of 7 or higher should be considered for surgical consultation, while those with scores of 3 or lower may not require a CT scan to rule out appendicitis 6.
• Patients with equivocal Alvarado scores (4-6) may benefit from adjunctive CT scans to confirm the diagnosis 6.