J Korean Surg Soc.  2010 Feb;78(2):100-105. 10.4174/jkss.2010.78.2.100.

Diagnostic Efficacy of the Alvarado Score according to Age in Acute Appendicitis

Affiliations
  • 1Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea. eastgate@ewha.ac.kr

Abstract

PURPOSE
This study aims to assess the diagnostic efficacy of the Alvarado score and to determine cut-off values of Alvarado score according to age for deciding on the options for patients with suspected appendicitis.
METHODS
From October 2008 to January 2009, we prospectively reviewed 152 patients with suspected appendicitis. The patients were classified into adults and children groups. We then determined cut-off values of the Alvarado score by analyzing each score's sensitivity and specificity.
RESULTS
Of the 147 patients, 96 patients were adults and 51 were children. The mean Alvarado score for adults and children were 6.08+/-1.85, and 6.69+/-1.43 in appendicitis and 4.32+/-2.02, and 4.60+/-1.81 in non-appendicitis, respectively. In adults, the sensitivity of the Alvarado scores 7 or higher for appendicitis was 66.2%, and the specificity was 67.7%. And the sensitivity of the Alvarado scores 4 or lower for non-appendicitis was 58.1%, and the specificity was 81.5%. In children, the sensitivity of the Alvarado scores 7 or higher for appendicitis was 80.8%, and the specificity was 68.0%. And the sensitivity of the Alvarado scores 4 or lower for non-appendicitis was 52.0%, and the specificity was 92.3%.
CONCLUSION
The cut-off values for Alvarado score were not different according to age of the patient. If the Alvarado score is 7 or higher, surgical management is recommended, and if the Alvarado score is 4 or lower, observation without CT or US is recommended. In equivocal appendicitis as defined by the Alvarado scores 5 to 6, adjunctive CT or US are recommended to confirm appendicitis.

Keyword

Acute appendicitis; Alvarado score; Age

MeSH Terms

Adult
Appendicitis
Child
Humans
Prospective Studies
Sensitivity and Specificity

Figure

  • Fig. 1 Frequency according to Alvarado score in adults.

  • Fig. 2 Frequency according to Alvarado score in children.


Reference

1. Jang SO, Kim BS, Moon DJ. Application of Alvarado score in patients with suspected appendicitis. Korean J Gastroenterol. 2008. 52:27–31.
2. Lee SM, Chang IT, Kim BG, Cha SJ, Kim YS, Pak JS. The efficacy of the Alvarado score in the diagnosis of acute appendicitis. J Korean Soc Coloproctol. 2008. 24:1–6.
3. Andersson M, Andersson RE. The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. World J Surg. 2008. 32:1843–1849.
4. Sun JS, Noh HW, Min YG, Lee JH, Kim JK, Park KJ, et al. Receiver operating characteristic analysis of the diagnostic performance of a computed tomographic examination and the Alvarado score for diagnosing acute appendicitis: emphasis on age and sex of the patients. J Comput Assist Tomogr. 2008. 32:386–391.
5. Petrosyan M, Estrada J, Chan S, Somers S, Yacoub WN, Kelso RL, et al. CT scan in patients with suspected appendicitis: clinical implications for the acute care surgeon. Eur Surg Res. 2008. 40:211–219.
6. 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. 25:489–493.
7. Schneider C, Kharbanda A, Bachur R. Evaluating appendicitis scoring systems using a prospective pediatric cohort. Ann Emerg Med. 2007. 49:778–841.
8. Yang ES, Yoon SK, Kim EY, Rho YI, Park SK, Park YB, et al. Usefulness of a Alvarado scoring system for the diagnosis of acute appendicitis in children. Korean J Pediatr Gastroenterol Nutr. 2004. 7:1–7.
9. Denizbasi A, Unluer EE. The role of the emergency medicine resident using the Alvarado score in the diagnosis of acute appendicitis compared with the general surgery resident. Eur J Emerg Med. 2003. 10:296–301.
10. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986. 15:557–564.
11. Yildirim E, Karagulle E, Kirbas I, Turk E, Hasdogan B, Teksam M, et al. Alvarado scores and pain onset in relation to multislice CT findings in acute appendicitis. Diagn Interv Radiol. 2008. 14:14–18.
12. Douglas CD, Macpherson NE, Davidson PM, Gani JS. Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. BMJ. 2000. 321:919–922.
13. Paulson EK, Kalady MF, Pappas TN. Clinical practice. Suspected appendicitis. N Engl J Med. 2003. 348:236–242.
14. Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med. 2004. 141:537–546.
15. Stroman DL, Bayouth CV, Kuhn JA, Westmoreland M, Jones RC, Fisher TL, et al. The role of computed tomography in the diagnosis of acute appendicitis. Am J Surg. 1999. 178:485–489.
16. Brandt MM, Wahl WL. Liberal use of CT scanning helps to diagnose appendicitis in adults. Am Surg. 2003. 69:727–732.
17. Rhea JT, Halpern EF, Ptak T, Lawrason JN, Sacknoff R, Novelline RA. The status of appendiceal CT in an urban medical center 5 years after its introduction: experience with 753 patients. AJR Am J Roentgenol. 2005. 184:1802–1808.
18. Zielke A, Sitter H, Rampp T, Bohrer T, Rothmund M. Clinical decision-making, ultrasonography, and scores for evaluation of suspected acute appendicitis. World J Surg. 2001. 25:578–584.
19. Martin AE, Vollman D, Adler B, Caniano DA. CT scans may not reduce the negative appendectomy rate in children. J Pediatr Surg. 2004. 39:886–890.
20. Hong JJ, Cohn SM, Ekeh AP, Newman M, Salama M, Leblang SD. A prospective randomized study of clinical assessment versus computed tomography for the diagnosis of acute appendicitis. Surg Infect (Larchmt). 2003. 4:231–239.
21. Smink DS, Finkelstein JA, Garcia Pena BM, Shannon MW, Taylor GA, Fishman SJ. Diagnosis of acute appendicitis in children using a clinical practice guideline. J Pediatr Surg. 2004. 39:458–463.
22. Poh AC, Lin M, Teh HS, Tan AG. The role of computed tomography in clinically-suspected but equivocal acute appendicitis. Singapore Med J. 2004. 45:379–384.
23. Vadeboncoeur TF, Heister RR, Behling CA, Guss DA. Impact of helical computed tomography on the rate of negative appendicitis. Am J Emerg Med. 2006. 24:43–47.
24. Macklin CP, Radcliffe GS, Merei JM, Stringer MD. A prospective evaluation of the modified Alvarado score for acute appendicitis in children. Ann R Coll Surg Engl. 1997. 79:203–205.
25. van den Broek WT, Bijnen BB, Rijbroek B, Gouma DJ. Scoring and diagnostic laparoscopy for suspected appendicitis. Eur J Surg. 2002. 168:349–354.
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