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.