The University of Southampton
University of Southampton Institutional Repository

The Alvarado score for predicting acute appendicitis: a systematic review

Record type: Article

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.

Full text not available from this repository.

Citation

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).

More information

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

Identifiers

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

Catalogue record

Date deposited: 25 Apr 2012 11:30
Last modified: 18 Jul 2017 06:03

Export record

Altmetrics

Contributors

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

University divisions


Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×