Alvarado score
The Alvarado score[1] is a clinical scoring system used in the diagnosis of appendicitis. The score has 6 clinical items and 2 laboratory measurements with a total 10 points. It was introduced in 1986 and although meant for pregnant females, it has been extensively validated in the non-pregnant population. The modified Alvarado score is at present in use.[2]
The score
Elements from the patient's history, the physical examination and from laboratory tests:
- Abdominal pain that migrates to the right iliac fossa
- Anorexia (loss of appetite) or ketones in the urine
- Nausea or vomiting
- Tenderness in the right iliac fossa
- Rebound tenderness
- Fever of 37.3 °C or more
- Leukocytosis, or more than 10000 white blood cells per microliter in the serum
- Neutrophilia, or an increase in the percentage of neutrophils in the serum white blood cell count.
The two most important factors, tenderness in the right lower quadrant and leukocytosis, are assigned two points, and the six other factors are assigned one point each, for a possible total score of ten points.
A score of 5 or 6 is compatible with the diagnosis of acute appendicitis. A score of 7 or 8 indicates a probable appendicitis, and a score of 9 or 10 indicates a very probable acute appendicitis.[3]
A popular mnemonic used to remember the Alvarado score factors is MANTRELS - Migration to the right iliac fossa, Anorexia, Nausea/Vomiting, Tenderness in the right iliac fossa, Rebound pain, Elevated temperature (fever), Leukocytosis, and Shift of neutrophils to the left (factors listed in the same order as presented above). Due to the popularity of this mnemonic, the Alvarado score is sometimes referred to as the MANTRELS score.
A useful mnemonic to remember the modified Alvarado score is: MAFLTRN - My Appendix Feels Likely To Rupture Now (2 points for T and L, one for all the others).
Complementary value
The original Alvarado score describes a possible total of 10 points, but those medical facilities that are unable to perform a differential white blood cell count, are using a Modified Alvarado Score with a total of 9 points which could be not as accurate as the original score. The high diagnostic value of the score has been confirmed in a number of studies across the world. The consensus is that the Alvarado score is a noninvasive, safe, diagnostic method, which is simple, reliable and repeatable, and able to guide the clinician in the management of the case. However, a recent study demonstrated a sensitivity of only 72% of the Alvarado Score for detection of appendicitis which has led to criticism of the usefulness of the score. Scores of less than five in children were useful for eliminating appendicitis from the differential diagnosis.[4]
Significance
It carries high significance in the diagnosis of acute appendicitis.[5][6][7][8][9][10]
See also
References
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- Bibliography
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