Alvarado score

The Alverado score[1] is a clinical scoring system used in the diagnosis of appendicitis. The score has 6 clinical items and 2 laboratory measurements with a total 10 points. It was introduced in 1986 and although meant for pregnant females, it has been extensively validated in the non-pregnant population. The modified Alvarado score is at present in use.[2]

The score

Elements from the patient'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.[3]

A popular mnemonic used to remember the Alvarado score factors is MANTRELS - Migration to the right iliac fossa, Anorexia, Nausea/Vomiting, Tenderness in the right iliac fossa, Rebound pain, Elevated temperature (fever), Leukocytosis, and Shift of neutrophils to the left (factors listed in the same order as presented above). Due to the popularity of this mnemonic, the Alvarado score is sometimes referred to as the MANTRELS score.

A useful mnemonic to remember the modified Alvarado score is: MAFLTRN - My Appendix Feels Likely To Rupture Now (2 points for T and L, one for all the others).

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 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.[4]

Significance

It carries high significance in the diagnosis of acute appendicitis.[5][6][7][8][9][10]

See also

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. ↑ Augustin, Goran (12 May 2014). Acute Abdomen During Pregnancy. Springer. p. 8. ISBN 978-3-319-05422-3.
  3. ↑ Douglas, CD (14 October 2000). "Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score". BMJ. 321 (7266): 919–919. doi:10.1136/bmj.321.7266.919.
  4. ↑ 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 2703737Freely accessible. PMID 17652298. Retrieved 2015-04-16.
  5. ↑ Crnogorac, S; Lovrenski, J (2000). "[Validation of the Alvarado score in the diagnosis of acute appendicitis].". Medicinski pregled. 54 (11-12): 557–61. PMID 11921691.
  6. ↑ 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.
  7. ↑ 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 2502264Freely accessible. PMID 7702329.
  8. ↑ 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 2502889Freely accessible. PMID 9196342.
  9. ↑ 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.
  10. ↑ 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
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