Can We Use the Alvarado Score to Determine Who Needs Imaging for Suspected Appendicitis?

Cheryl Lynn Horton, MD

CT imaging adds diagnostic value for patients with intermediate Alvarado scores.

To determine if use of the Alvarado score could minimize unnecessary computed tomography (CT) imaging, researchers in Singapore evaluated 350 patients who underwent CT imaging for suspected appendicitis over a 1-year period. Alvarado scores were calculated at admission and were compared to final pathology and CT scan reports.

Forty-eight percent of patients underwent surgery. The overall prevalence of appendicitis was 44%. The negative appendectomy rate was 7.7%. Alvarado scores ≥7 in men and ≥9 in women had positive likelihood ratios for appendicitis of 4.1 and 6.5, respectively, similar to the positive likelihood ratio of CT imaging.

Citation(s):

Tan WJ et al. Prospective comparison of the Alvarado Score and CT scan in the evaluation of suspected appendicitis: A proposed algorithm to guide CT use. J Am Coll Surg 2014 Oct 25; [e-pub ahead of print].