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    Alvarado Score for Acute Appendicitis

    Predicts likelihood of appendicitis diagnosis.
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    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:

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    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