Modified Alvarado scoring system for diagnosis of appendicitis in children

January 01, 0001

Modified Alvarado scoring system for diagnosis of appendicitis in children

This retrospective medical records review by US authors was undertaken to determine the Alvarado score for each patient and correlate it with the pathological findings and imaging studies in community teaching hospital. The intention was to evaluate the efficacy scoring system to partially replace computed tomography (CT) and its attendant radiation exposure. They included 61 patients aged 3 to 16 years, admitted with suspected acute appendicitis.

They found: "The standard Alvarado score for acute appendicitis had a sensitivity of 92% and a specificity of 82%, with an accuracy of 92%. In the modified Alvarado scoring system, CT findings were substituted for Alvarado scores in the ranges of 5 or 6, 5 to 7, 5 to 8, and 5 to 9. The modification resulted in the greatest accuracy (98%) in diagnosing appendicitis in patients with scores in the range of 5 to 7. This modification theoretically would have decreased the use of CT by about 27% in this group of retrospectively studied patients. Furthermore, in patients with Alvarado scores of 1 to 4, another diagnosis should be considered; in patients with scores of 5 to 7, CT should be performed; and, in patients with scores of 8 to 10, an appendectomy should be performed promptly without further studies."

The authors concluded: "The modified Alvarado score is useful as an aid in diagnosing acute appendicitis in the pediatric population. This scoring system eliminates unnecessary use of CT and the attendant potential cancer-inducing radiation in the pediatric population."

The use of a high performing scoring system such as this one also may reduce delays and costs, and a further report on those aspects is warranted.

For the full abstract, click here.

Arch Surg 146(1):64-67, January 2011 © 2011 to the American Medical Association
Modified Alvarado scoring system for diagnosis of appendicitis in children. Amy Rezak, Hussain M. A. Abbas, Michael S. Ajemian, Stanley J. Dudrick, Edward M. Kwasnik. Correspondence to Dr. Ajemian: [email protected]

Category: D. Digestive. Keywords: acute appendicitis, children, Alvarado score, computed tomography, diagnostic test study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 1 February 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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