Alvarado score

The Alvarado score is a clinical scoring system used in the diagnosis of appendicitis.[1] Alvarado scoring has largely been superseded as a clinical prediction tool by the Appendicitis Inflammatory Response score.[2][3][4]

Alvarado score
PurposeDiagnosis of appendicitis

Also known by the mnemonic MANTRELS, the scale has 6 clinical items (3 signs and 3 symptoms) and 2 laboratory measurements, each given an additive point score, with a maximum of 10 points possible.[5] It was introduced in 1986 by Dr. Alfredo Alvarado and although meant for pregnant females, it has been extensively validated in the non-pregnant population. A known limitation of the score is that only 20% of elderly patients present with classic findings on which the score focuses.[5] A modified Alvarado score is at present in use.[6]

The score
Alvarado score
Symptoms
Abdominal pain that migrates to the right iliac fossa1
Anorexia (loss of appetite) or ketones in the urine1
Nausea or vomiting1
Tenderness in the right iliac fossa2
Signs
Rebound tenderness1
Fever of 37.3 °C or more1
Laboratory
Leukocytosis > 10,0002
Neutrophilia > 70%1
TOTAL10

Elements from the person's history, the physical examination and from laboratory tests:

The two most important factors, tenderness in the right lower quadrant and leukocytosis, are assigned two points, and the six other factors are assigned one point each, for a possible total score of ten points.

A score of 5 or 6 is compatible with the diagnosis of acute appendicitis. A score of 7 or 8 indicates a probable appendicitis, and a score of 9 or 10 indicates a very probable acute appendicitis.[7]

Complementary value

The original Alvarado score describes a possible total of 10 points, but those medical facilities that are unable to perform a differential white blood cell count, are using a Modified Alvarado Score with a total of 9 points which could be not as accurate as the original score. The high diagnostic value of the score has been confirmed in a number of studies across the world. The consensus is that the Alvarado score is a noninvasive, safe, diagnostic method, which is simple, reliable and repeatable, and able to guide the clinician in the management of the case. However, a recent study demonstrated a sensitivity of only 72% of the Modified Alvarado Score for detection of appendicitis which has led to criticism of the usefulness of the score. Scores of less than five in children were useful for eliminating appendicitis from the differential diagnosis.[8]

Significance

It carries high significance in the diagnosis of acute appendicitis.[9][10][11][12][13][14]

References
  1. Alvarado, A (May 1986). "A practical score for the early diagnosis of acute appendicitis". Annals of Emergency Medicine. 15 (5): 557–64. doi:10.1016/S0196-0644(86)80993-3. PMID 3963537.
  2. Andersson, Manne; Andersson, Roland E. (August 2008). "The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score". World Journal of Surgery. 32 (8): 1843–1849. doi:10.1007/s00268-008-9649-y. ISSN 0364-2313. PMID 18553045. S2CID 12194652.
  3. de Castro, S. M. M.; Ünlü, Ç.; Steller, E. Ph.; van Wagensveld, B. A.; Vrouenraets, B. C. (July 2012). "Evaluation of the Appendicitis Inflammatory Response Score for Patients with Acute Appendicitis". World Journal of Surgery. 36 (7): 1540–1545. doi:10.1007/s00268-012-1521-4. ISSN 0364-2313. PMC 3368113. PMID 22447205.
  4. Kollár, D.; McCartan, D. P.; Bourke, M.; Cross, K. S.; Dowdall, J. (2014-09-23). "Predicting Acute Appendicitis? A comparison of the Alvarado Score, the Appendicitis Inflammatory Response Score and Clinical Assessment". World Journal of Surgery. 39 (1): 104–109. doi:10.1007/s00268-014-2794-6. ISSN 0364-2313. PMID 25245432. S2CID 19458996.
  5. Martinez JP (2007). "Evaluation and Management of the Patient with Abdominal Pain". In Mattu A, Goyal D (eds.). Emergency Medicine. Malden, Massachusetts: Blackwell (BMJ Books). p. 28. ISBN 978-1-4051-4166-6. Retrieved 2022-04-15 – via OpenLibrary.
  6. Augustin, Goran (12 May 2014). "Aute Appendicitis". Acute Abdomen During Pregnancy. Springer. p. 8. ISBN 978-3-319-05422-3 – via Google Books.
  7. Douglas, CD (14 October 2000). "Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score". BMJ. 321 (7266): 919–22. doi:10.1136/bmj.321.7266.919. PMC 27498. PMID 11030676.
  8. Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE (2007). "Does this child have appendicitis?". JAMA. 298 (4): 438–51. doi:10.1001/jama.298.4.438. PMC 2703737. PMID 17652298.
  9. Crnogorac, S; Lovrenski, J (2000). "[Validation of the Alvarado score in the diagnosis of acute appendicitis]". Medicinski Pregled (in Croatian). 54 (11–12): 557–61. PMID 11921691.
  10. Chan, MY; Teo, BS; Ng, BL (September 2001). "The Alvarado score and acute appendicitis". Annals of the Academy of Medicine, Singapore. 30 (5): 510–2. PMID 11603135.
  11. Kalan, M; Talbot, D; Cunliffe, WJ; Rich, AJ (Nov 1994). "Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study". Ann R Coll Surg Engl. 76 (6): 418–419. PMC 2502264. PMID 7702329.
  12. Macklin, CP; Radcliffe, GS; Merei, JM; Stringer, MD (May 1997). "A prospective evaluation of the modified Alvarado score for acute appendicitis in children". Annals of the Royal College of Surgeons of England. 79 (3): 203–5. PMC 2502889. PMID 9196342.
  13. Meltzer, Andrew C.; Baumann, Brigitte M.; Chen, Esther H.; Shofer, Frances S.; Mills, Angela M. (August 2013). "Poor Sensitivity of a Modified Alvarado Score in Adults With Suspected Appendicitis". Annals of Emergency Medicine. 62 (2): 126–131. doi:10.1016/j.annemergmed.2013.01.021. PMID 23623557.
  14. Al Qahtani, HH; Muhammad, AA (May 2004). "Alvarado score as an admission criterion for suspected appendicitis in adults". Saudi Journal of Gastroenterology. 10 (2): 86–91. PMID 19861831.
Bibliography
  • McKay R, Shepherd J (2007). "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. 25 (5): 489–93. doi:10.1016/j.ajem.2006.08.020. PMID 17543650.
  • Khan I, Rehman A (2005). "Application of Alvarado scoring system in diagnosis of acute appendicitis". J Ayub Med Coll Abbottabad. 17 (3): 41–44. PMID 16320795.

Online calculator of the Alvarado Score

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