Alvarado Score for Acute Appendicitis

Diagnose appendicitis

About

The Alvarado score was developed to assist in diagnosing appendicitis.

Studies that look at the score's ability to rule out appendicitis (using Alvarado < 3-4) have a sensitivity of 96%. Studies that use the score to rule in appendicitis (using Alvarado > 6-7) have a sensitivity of 58-88%, depending on the study and score cutoffs used.

McKay et al. recommend a CT scan for a score of 4-6 and surgical consultation for a score ≥ 7. For a score of ≤ 3, the authors suggest that a CT scan is unnecessary for diagnosing appendicitis given the low likelihood of appendicitis.

A score is assigned by the following variables.

  • +2 points - Right lower quadrant tenderness
  • +1 point - Elevated temperature (>37.3°C or 99.1°F)
  • +1 point - Rebound tenderness
  • +1 point - Migration of pain to the right lower quadrant
  • +1 point - Anorexia
  • +1 point - Nausea or vomiting
  • +2 point - Leukocytosis > 10,000
  • +1 point - Leukocyte left shift

References

Alvarado A.

Annals of Emergency Medicine 1986, 15 (5): 557-64

The Alvarado Score for Acute Appendicitis calculator is created by QxMD.

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1. Right Lower Quadrant Tenderness?

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