Indication of an Abdominal CT Scan Using Alvarado Score in Patients Suspected Appendicitis

You, Yeon Ho; Park, Jung Soo; Park, Sung Soo; Park, Jung Kyu; Kim, Seung Whan; Chung, Sung Pil; Yoo, In Sool

Abstract

PURPOSE
Although several diagnostic techniques have been introduced to evaluate appendicitis, no guidelines exists to determine which patients would benefit from these techniques. For that reason, we designed this study to use the Alvarado score to find the subgroup of patients that require CT scans.
METHODS
We evaluated the medical records of patients who presented with non-traumatic right lower abdominal pain from Mar to Sep 2003. According to the initial Alvarado score, the patients were divided in a high score group and a low score group. The differences in the diagnostic accuracy were compared for each group according to the CT scan when the reference Alvarado score (AS) was changed.
RESULTS
Among two hundred patients, 106 underwent a CT scan. Of those 200 patients, 42 were in the high score group, and 158 were in the low score group, when the cutoff AS was 7. The diagnostic accuracy did not differ in the high score group according to the CT scan. However, a significant difference existed in the low score group and in the high score group (97% vs 80%). The difference in the diagnostic accuracy was greatest at a cutoff AS of 5.
CONCLUSION
This study suggests that a CT scan should be recommended for patients with right lower quadrant abdominal pain when the Alvarado score is less than or equal to 5.