Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

    Disease

    Select...

    Specialty

    Select...

    Chief Complaint

    Select...

    Organ System

    Select...

    Patent Pending

    Log In

    Show
    Forgot your password?
    Log In
    Or create a new account (it's free)

    Forgot Password?

    Enter your email address and we'll send you a link to reset your password.

    Get New Password

    Sign In Required

    To save favorites, you must log in.

    Creating an account is free, easy, and takes about 60 seconds.

    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.
    Save your unit preferences in settings!

    Alvarado Score for Acute Appendicitis

    Predicts likelihood of appendicitis diagnosis.
    Favorite
    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with suspected acute appendicitis (typically with right lower quadrant pain).

    • More accurate at extremes than for equivocal scores, so it is unclear whether Alvarado scoring is better than gestalt.

    • Symptoms may overlap with other diseases; i.e., higher scores are found in patients with non-appendiceal inflammatory conditions, such as diverticulitis or acute pelvic inflammatory disease. It is important to consider the whole clinical picture in making the diagnosis of appendicitis.

    • Note that several modifications of the score exist, which may be appropriate in specific settings such as pregnant patients, children, and low-resource settings (without lab availability), but the original Alvarado Score remains the best studied and validated in a general population.

    Acute appendicitis is the most common surgical emergency in the US. Diagnostic accuracy is increased with greater usage of CT scanning; however, CT confers risks and disadvantages such as cost, radiation exposure, and contrast-related complications. The Alvarado Score is a well-established and widely-used clinical decision tool that may help reduce CT usage.

    Signs
    No
    0
    Yes
    +2
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    Symptoms
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    Laboratory Values
    No
    0
    Yes
    +2
    No
    0
    Yes
    +1

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    Advice

    Always consider other causes of right lower quadrant pain in your differential diagnosis, including (but not limited to): urologic disease (like kidney stone), ovarian pathology (torsion, tubo-ovarian abscess), and other GI pathology (colitis, diverticulitis).

    Management

    • Cutoffs differ by study, but one validated stratification assigns the highest risk to scores ≥9 in males or ≥10 in females and lowest risk to scores ≤1 in males or ≤2 in females (Coleman 2018).

    • In patients who are high risk, consider treatment without CT imaging, and in patients who are low risk, consider alternative diagnoses.

    Content Contributors
    • Ayomide Loye, MD
    • Xiao Chi Zhang, MD, MS
    About the Creator
    Dr. Alfredo Alvarado
    Are you Dr. Alfredo Alvarado?
    Content Contributors
    • Ayomide Loye, MD
    • Xiao Chi Zhang, MD, MS