Also known by the mnemonic MANTRELS, the scale has 6 clinical items (3 signs and 3 symptoms) and 2 laboratory measurements, each given an additive point score, with a maximum of 10 points possible.[5] It was introduced in 1986 by Dr. Alfredo Alvarado and although meant for pregnant females, it has been extensively validated in the non-pregnant population. A known limitation of the score is that only 20% of elderly patients present with classic findings on which the score focuses.[5] A modified Alvarado score is at present in use.[6]
The score
Alvarado score
Symptoms
Abdominal pain that migrates to the right iliac fossa
1
Anorexia (loss of appetite) or ketones in the urine
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.[7]
A score of 5 or 6 is compatible with the diagnosis of acute appendicitis. A score of 7 or 8 indicates probable appendicitis, and a score of 9 or 10 indicates very probable acute appendicitis.[8]
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, 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 Modified 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.[9]
Significance
It carries high significance in the diagnosis of acute appendicitis.[10]
References
^Alvarado, A (May 1986). "A practical score for the early diagnosis of acute appendicitis". Annals of Emergency Medicine. 15 (5): 557–64. doi:10.1016/S0196-0644(86)80993-3. PMID3963537.
^Andersson, Manne; Andersson, Roland E. (August 2008). "The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score". World Journal of Surgery. 32 (8): 1843–1849. doi:10.1007/s00268-008-9649-y. ISSN0364-2313. PMID18553045. S2CID12194652.
^Kollár, D.; McCartan, D. P.; Bourke, M.; Cross, K. S.; Dowdall, J. (2014-09-23). "Predicting Acute Appendicitis? A comparison of the Alvarado Score, the Appendicitis Inflammatory Response Score and Clinical Assessment". World Journal of Surgery. 39 (1): 104–109. doi:10.1007/s00268-014-2794-6. ISSN0364-2313. PMID25245432. S2CID19458996.
^ abMartinez JP (2007). "Evaluation and Management of the Patient with Abdominal Pain". In Mattu A, Goyal D (eds.). Emergency Medicine. Malden, Massachusetts: Blackwell (BMJ Books). p. 28. ISBN978-1-4051-4166-6. Retrieved 2022-04-15 – via OpenLibrary.
^Crnogorac, S; Lovrenski, J (2000). "[Validation of the Alvarado score in the diagnosis of acute appendicitis]". Medicinski Pregled (in Croatian). 54 (11–12): 557–61. PMID11921691.
Bibliography
McKay R, Shepherd J (2007). "The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED". Am J Emerg Med. 25 (5): 489–93. doi:10.1016/j.ajem.2006.08.020. PMID17543650.
Khan I, Rehman A (2005). "Application of Alvarado scoring system in diagnosis of acute appendicitis". J Ayub Med Coll Abbottabad. 17 (3): 41–44. PMID16320795.
