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The Alvarado score for predicting acute appendicitis: a systematic review

The Alvarado score for predicting acute appendicitis: a systematic review
The Alvarado score for predicting acute appendicitis: a systematic review
Background: The Alvarado score can be used to stratify patients with symptoms of suspected appendicitis; the validity of the score in certain patient groups and at different cut points is still unclear. The aim of this study was to assess the discrimination (diagnostic accuracy) and calibration performance of the Alvarado score.

Methods: A systematic search of validation studies in Medline, Embase, DARE and The Cochrane library was performed up to April 2011. We assessed the diagnostic accuracy of the score at the two cut-off points: score of 5 (1 to 4 vs. 5 to 10) and score of 7 (1 to 6 vs. 7 to 10). Calibration was analysed across low (1 to 4), intermediate (5 to 6) and high (7 to 10) risk strata. The analysis focused on three sub-groups: men, women and children.

Results: Forty-two studies were included in the review. In terms of diagnostic accuracy, the cut-point of 5 was good at 'ruling out' admission for appendicitis (sensitivity 99% overall, 96% men, 99% woman, 99% children). At the cut-point of 7, recommended for 'ruling in' appendicitis and progression to surgery, the score performed poorly in each subgroup (specificity overall 81%, men 57%, woman 73%, children 76%). The Alvarado score is well calibrated in men across all risk strata (low RR 1.06, 95% CI 0.87 to 1.28; intermediate 1.09, 0.86 to 1.37 and high 1.02, 0.97 to 1.08). The score over-predicts the probability of appendicitis in children in the intermediate and high risk groups and in women across all risk strata.

Conclusions: The Alvarado score is a useful diagnostic 'rule out' score at a cut point of 5 for all patient groups. The score is well calibrated in men, inconsistent in children and over-predicts the probability of appendicitis in women across all strata of risk.
139-[13pp]
Ohle, Robert
db92d15d-bb5b-446c-b965-e3a51e70cd61
O'Reilly, Fran
9ec9fc45-5cad-4484-b754-85262c297210
O'Brien, Kirsty K.
f37fb7f3-541f-4f3b-954c-e66273961c8a
Fahey, Tom
c0fd145a-af82-4c37-bce0-1c2e3e30c0f9
Dimitrov, Borislav D.
366d715f-ffd9-45a1-8415-65de5488472f
Ohle, Robert
db92d15d-bb5b-446c-b965-e3a51e70cd61
O'Reilly, Fran
9ec9fc45-5cad-4484-b754-85262c297210
O'Brien, Kirsty K.
f37fb7f3-541f-4f3b-954c-e66273961c8a
Fahey, Tom
c0fd145a-af82-4c37-bce0-1c2e3e30c0f9
Dimitrov, Borislav D.
366d715f-ffd9-45a1-8415-65de5488472f

Ohle, Robert, O'Reilly, Fran, O'Brien, Kirsty K., Fahey, Tom and Dimitrov, Borislav D. (2011) The Alvarado score for predicting acute appendicitis: a systematic review. BMC Medicine, 9 (1), 139-[13pp]. (doi:10.1186/1741-7015-9-139). (PMID:22204638)

Record type: Article

Abstract

Background: The Alvarado score can be used to stratify patients with symptoms of suspected appendicitis; the validity of the score in certain patient groups and at different cut points is still unclear. The aim of this study was to assess the discrimination (diagnostic accuracy) and calibration performance of the Alvarado score.

Methods: A systematic search of validation studies in Medline, Embase, DARE and The Cochrane library was performed up to April 2011. We assessed the diagnostic accuracy of the score at the two cut-off points: score of 5 (1 to 4 vs. 5 to 10) and score of 7 (1 to 6 vs. 7 to 10). Calibration was analysed across low (1 to 4), intermediate (5 to 6) and high (7 to 10) risk strata. The analysis focused on three sub-groups: men, women and children.

Results: Forty-two studies were included in the review. In terms of diagnostic accuracy, the cut-point of 5 was good at 'ruling out' admission for appendicitis (sensitivity 99% overall, 96% men, 99% woman, 99% children). At the cut-point of 7, recommended for 'ruling in' appendicitis and progression to surgery, the score performed poorly in each subgroup (specificity overall 81%, men 57%, woman 73%, children 76%). The Alvarado score is well calibrated in men across all risk strata (low RR 1.06, 95% CI 0.87 to 1.28; intermediate 1.09, 0.86 to 1.37 and high 1.02, 0.97 to 1.08). The score over-predicts the probability of appendicitis in children in the intermediate and high risk groups and in women across all risk strata.

Conclusions: The Alvarado score is a useful diagnostic 'rule out' score at a cut point of 5 for all patient groups. The score is well calibrated in men, inconsistent in children and over-predicts the probability of appendicitis in women across all strata of risk.

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Published date: 28 December 2011
Organisations: Primary Care & Population Sciences

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Local EPrints ID: 337367
URI: http://eprints.soton.ac.uk/id/eprint/337367
PURE UUID: 09619e02-fddf-404a-85d2-e75073f7c586

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Date deposited: 25 Apr 2012 11:30
Last modified: 14 Mar 2024 10:52

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Contributors

Author: Robert Ohle
Author: Fran O'Reilly
Author: Kirsty K. O'Brien
Author: Tom Fahey
Author: Borislav D. Dimitrov

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