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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
Reference
Alvarado A.
A practical score for the early diagnosis of acute appendicitis.
Ann Emerg Med. 1986; 15(5): 557-64.Â
McKay R, Shepherd J.
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. 2007; 25(5): 489-93.Â
Douglas CD, Macpherson NE, Davidson PM, Gani JS.
Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score.
BMJ. 2000; 321(7266): 919-22.Â
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