Use of the Alvarado Score in the Diagnosis of Acute Appendicitis in Children

Abstract

Purpose: Acute appendicitis is the most common surgical condition of abdomen in children and the diagnosis is still challenging. The aim of this study was to evaluate the diagnostic value of the Alvarado score and computed tomography (CT) scan and to provide guidance for CT scan to reduce the number of CT examinations for clinically suspected acute appendicitis in children. Methods: We retrospectively analyzed pediatric patients aged below 18 years and screened via abdominal CT for suspected appendicitis at Yeungnam University Hospital between January 1, 2013 and October 31, 2018. The Alvarado scores of all patients were calculated and correlated with pathology and CT findings. Results: A total of 198 patients aged between 5 and 18 years were reviewed, and 87 patients underwent surgery whereas 81 patients (40.9%, 81/198) were diagnosed with acute appendicitis pathologically. Six patients underwent negative appendectomy (6.9%, 6/87). The mean Alvarado score was 7.3±1.6 in the appendicitis group and 3.9±1.7 in the non-appendicitis group (p<0.01). A total of 79 positive CT cases were detected in the group with clinically suspected appendicitis. The CT scan yielded 8 false-negative and 6 false-positive results. The sensitivity and specificity of CT scan were 90.1% and 94.8%, respectively, and the sensitivity and specificity of Alvarado score were 75.6% and 89.1%, respectively (p<0.01). The proportion of cases with appendicitis carrying an Alvarado score less than 3 was 4.2% (3/71), and that of patients with Alvarado score greater than 8 was 95.8% (46/48). Conclusion: The Alvarado score facilitates risk stratification of patients and is expected to guide the reasonable use of CT scan especially in patients with low (less than 3) and high (more than 8) scores.