Alvarado Score for Acute Appendicitis
Likelihood of appendicitis based on symptoms, signs, and lab data.
Favorite
When to Use
Pearls/Pitfalls
Any patient with suspected appendicitis (typically with right lower quadrant abdominal pain).
- The Alvarado Score requires laboratory values in addition to history and physical exam findings.
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A modified version of the Alvarado Score, which excludes the leukocyte left shift input, has been validated for use in settings where measurement of left shift of neutrophils may not be available (i.e., low resource settings).
Signs
No
0Yes
+2No
0Yes
+1No
0Yes
+1Symptoms
No
0Yes
+1No
0Yes
+1No
0Yes
+1Laboratory Values
No
0Yes
+2No
0Yes
+1Result:
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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).
Formula
Addition of assigned points.
Facts & Figures
- As the Alvarado Score is numerical, it has been evaluated for ruling in and ruling out appendicitis.
- Studies ruling out appendicitis (using Alvarado < 3-4) have a sensitivity of 96%;
- Studies ruling in appendicitis (using Alvarado > 6-7) have a sensitivity of 58-88%, depending on the study and score cutoffs used.
- The 2007 McKay study recommends CT scan for Alvarado 4-6, surgical consultation for Alvarado ≥ 7, and for Alvarado ≤ 3, no CT for diagnosing appendicitis, as appendicitis is unlikely.
Literature
Original/Primary Reference
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986 May;15(5):557-64. PubMed PMID: 3963537.Other References
Kalan M, Talbot D, Cunliffe WJ, Rich AJ. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Engl. 1994;76(6):418-9. Douglas CD, Macpherson NE, Davidson PM, Gani JS. Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. BMJ. 2000 Oct 14;321(7266):919-22. PubMed PMID: 11030676; PubMed Central PMCID: PMC27498.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 Jun;25(5):489-93. PubMed PMID: 17543650.
Dr. Alfredo Alvarado
About the Creator
Alfredo Alvarado, MD, is a retired general surgeon, formerly at Plantation General Hospital in Florida. He previously held staff positions at Florida Medical Center and Westside Regional Hospital. Dr. Alvarado completed medical training at the National University of Colombia and residencies in general and thoracic surgery.
To view Dr. Alfredo Alvarado's publications, visit PubMed
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