Journal List > J Korean Surg Soc > v.78(2) > 1011072

Oh, Kim, Lee, and Chung: Diagnostic Efficacy of the Alvarado Score according to Age in Acute Appendicitis

Abstract

Purpose

This study aims to assess the diagnostic efficacy of the Alvarado score and to determine cut-off values of Alvarado score according to age for deciding on the options for patients with suspected appendicitis.

Methods

From October 2008 to January 2009, we prospectively reviewed 152 patients with suspected appendicitis. The patients were classified into adults and children groups. We then determined cut-off values of the Alvarado score by analyzing each score's sensitivity and specificity.

Results

Of the 147 patients, 96 patients were adults and 51 were children. The mean Alvarado score for adults and children were 6.08±1.85, and 6.69±1.43 in appendicitis and 4.32±2.02, and 4.60±1.81 in non-appendicitis, respectively. In adults, the sensitivity of the Alvarado scores 7 or higher for appendicitis was 66.2%, and the specificity was 67.7%. And the sensitivity of the Alvarado scores 4 or lower for non-appendicitis was 58.1%, and the specificity was 81.5%. In children, the sensitivity of the Alvarado scores 7 or higher for appendicitis was 80.8%, and the specificity was 68.0%. And the sensitivity of the Alvarado scores 4 or lower for non-appendicitis was 52.0%, and the specificity was 92.3%.

Conclusion

The cut-off values for Alvarado score were not different according to age of the patient. If the Alvarado score is 7 or higher, surgical management is recommended, and if the Alvarado score is 4 or lower, observation without CT or US is recommended. In equivocal appendicitis as defined by the Alvarado scores 5 to 6, adjunctive CT or US are recommended to confirm appendicitis.

Figures and Tables

Fig. 1
Frequency according to Alvarado score in adults.
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Fig. 2
Frequency according to Alvarado score in children.
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Table 1
Alvarado scoring system
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*2~5 yrs: >14,500, 6~11 yrs: >13,500, ≥12 yrs: >10,000; 2~5 yrs: >55.2%, 6~11 yrs: >59.3%, ≥12 yrs: >75.2%.

Table 2
Result of Alvarado score according to the pathologic findings
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Table 3
Findings of CT or US negative group
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Table 4
Alvarado scores of patients
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Table 5
Statistical value according to Alvarado score
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*PPV = positive predictive value; NPV = negative predictive value; FP = false positive; §FN = false negative; AS = Alvarado score.

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