Application of Alvarado Score in Patients with Suspected Appendicitis

Jang, Sung Ouk; Kim, Byung Seok; Moon, Duk Jin

Abstract

BACKGROUND/AIMS: Though acute appendicitis is one of the most common surgical conditions, the diagnosis in patients with equivocal signs can be difficult. Many patients with suspected appendicitis are admitted for observation. We designed this study to investigate whether the Alvarado score can be used as an admission criterion.
METHODS
This is a prospective study comprising consecutive patients who attended the emergency room with right lower abdominal pain from January 2007 to March 2007. Patients were scored with the Alvarado score and if they were admitted, had a second scoring in the ward. Patients who were not admitted were told to attend the clinic the next day and patients who did not attend the clinic were interviewed by telephone.
RESULTS
Total of 132 patients (M=83, F=49) were included and 105 patients were admitted for observation. Eighty-seven patients had surgery with the intention to treat appendicitis and 10 patients did not have appendicitis. The diagnosis of acute appendicitis was highly accurate for an Alvarado score above 6 (90.9%). Patients with a score 4 or less in the ward as well as in the emergency room did not have appendicitis. Of the patients with appendicitis, 49% (38/77) had higher scores in the ward than initial score at the emergency room.
CONCLUSIONS
None of the patients with a score of 4 or less had appendicitis. They did not need admission. The Alvarado score can be used as an admission criterion in patients with suspected appendicitis.