Alvarado score

The Alvarado score is a clinical scoring system used in the diagnosis of appendicitis. The score has 6 clinical items and 1 laboratory measurement which total 9 points.

Additional recommended knowledge

Essential Laboratory Skills Guide

Daily Sensitivity Test

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The score

• Abdominal pain that migrates to the right iliac fossa
• Anorexia (loss of apetite) or ketones in the urine
• Nausea or vomiting
• Pain on pressure in the right fossa
• Rebound tenderness
• Fever of 37.5°C or more
• >10000 white blood cells per microliter in the serum

A score of less than 5 is not likely appendicitis, 5 or 6 is equivocal, 7 or 8 is probably appendicitis and 9 points means that the patient is highly likely to have appendicitis.

Complementary value

The Alvarado score has a very low sensitivity and a low specificity, especially in women who can have gynecological diseases mimicking appendicitis. The score has been modified to try and find adapted scores with higher clinical importance. Trials have studied the usefulness for the score in guiding the management of patients with pain in the right fossa, for example to see which patients need a CT scan and which patients need surgery.

See also

• Appendicitis

References

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. PMID 17543650