Alvarado score :

1
Alvarado score an admission criterion
in patients with right iliac fossa pain
M.Y.P. Chan, C.Tan, M.T. Chiu,
Y.Y.Ng Alexandra Hospital, Singapore Surg
J R Coll Surg Edinb Irel., 1 February 2003,
39-41
Reviewed by Serguei Fedorine
2
INTRODUCTION

• Appendicitis commonly considered in patients
  with RIF pain
• Patients with equivocal signs - present a
  diagnostic challenge
• Admissions for observation are common
• Previous studies
• ? Alvarado score (less than 5) rules out
  appendicitis
• ? Alvarado score (less than 6) rules out
  perforated appendicitis

3
AIM OF THE STUDY

• Can the Alvarado score can be used
• by AE as a criteria for admission?

4
MATERIALS AND METHODS

• Prospective study
• Consecutive series of patients with ? A.
  Appendicitis over 5 months in A/E
• The Alvarado score
• ? three symptoms
• ? three signs
• ? two laboratory findings

5
MATERIALS AND METHODS
The Alvarado score

Symptoms
Score ? migratory
right iliac fossa pain
1 ? nausea/vomiting
1
? anorexia
1
Signs ? RIF tenderness
2
? fever gt37.30C
1
? rebound pain in RIF
1
Laboratory test ? leucocytosis
(gt10 X 109/L)
2
? neutrophilic shift to the left gt75
1 Total score

10
6
MATERIALS AND METHODS

• Patients were scored in the emergency
  department
• If admitted - second scoring in the ward
• If discharged review within 24/24
• The decision for admission and surgery was made
  independent of the score
• Diagnosis of operated patients - confirmed by
  operative findings and histology
• Normal appendicectomy - non-inflamed appendix
  was removed

7
RESULTS

• 175 patients
• ? 130 males
• ? 45 females
• Age 8 - 73 years (mean 30 years)
• 60.5 - referred from another doctor
• 149 (85) - admitted for observation
• 2 patients had surgery for other conditions

8
RESULTS

• 89 patients - surgery with the intention to
  treat appendicitis
• 14 patients did not have appendicitis
• the normal appendicectomy rate was 13

9
RESULTS

• In patients with appendicitis
• ? 41 (31/75) - higher than initial score on the
  ward

10
DISCUSSION

• Appendicitis remains a diagnostic challenge
• ? many diagnostic scores described
• ? many are complex and difficult to
  implement
• The Alvarado score - described in 1988
• ? simple scoring system
• ? can be easily implemented in the outpatient
  setting

11
DISCUSSION

• No appendicitis if score of 4 or less
• potential to reduced admissions by 20
• discharged patients did not require surgery

12
DISCUSSION

• scoring may not be accurate if
• ? patients unable to give a proper history
• ? very young
• ? those with communication problems

13
CONCLUSION

• The Alvarado score - objective criterion
• in selecting patients for admission
• Review patients in 24/24 or if symptoms worsen

14
CONCLUSION
15
APPRAISAL OF THE STUDY

• problem formulated clearly
• prospective
• appropriate inclusion criteria
• who assessed the patients in A/E ?
• ? A/E vs. surgical registrar
• rebound RIF pain
• ? do we always have to check it?
• ? A/E vs. surgical registrar

16
APPRAISAL OF THE STUDY

• can the alvarado score be used as an
  independent criteria for admission?
• ? further larger studies are needed
• importance of the study
• ? use of the simplified approach for assessment
  of
• patients with RIF pain
• ? great potential to reduce the number of
  admissions
• ? possible use by A/E staff
• ? not every RIF pain is an indication for
  surgical review