Alvarado Score in the Diagnosis of Acute Appendicitis: Correlation with the Tomographic and Intra-Operative Findings

Acute appendicitis (AA) is one of the most common causes of abdominal pain, accounting for about one-third of patients presenting to emergency services with acute abdomen. Surgeons perform about 280,000 appendectomies per year in the United States [1-3]. Despite the high prevalence, its diagnosis remains a challenge mainly among young, elderly and women of childbearing age, where a number of other inflammatory, genitourinary and gynecological conditions may present signs and symptoms that are similar to this condition [2] A delay in performing the appendectomy increases the risk of perforation of the appendix, which increases the morbidity and mortality [2] A high degree of suspicion is essential for the diagnosis of this patology. The diagnosis of in patients with typical clinical findings can be made based on clinical and laboratory tests. Pains in the lower right quadrant, migration of pain, anorexia, nausea or vomiting, fever, leukocytosis are effective and practical criteria for such diagnosis. However, about one-third of the patients will present with atypical clinical and laboratory findings, requiring radiological complementation [1,4]. Thus, a numerical scale was created by Alvarado based on clinical data and blood count to identify the probability of being a case of AA [5]. Alvarado’s original work was published in 1988 and is based on his retrospective analysis of data from 305 Patients with abdominal pain suggesting AA. Eight predictive factors of diagnostic value in AA were identified and a score of 1 or 2 was assigned to each factor based on its predictive value for diagnosis [5,6]. The score of 1 was given for each of the criteries following: elevation of temperature greater than 37.3°C, pain in the lower right quadrant, migratory pain to the lower right quadrant, anorexia, nausea or vomiting, and increased granulocytic series. The Alvarado score (AS) of 2 was given for two criteries: discomfort in the lower right quadrant and leukocytosis (> 10,000) [5,6]. Conduct recommendations are given based on the total score. An AS between 5-6 is “compatible” with the diagnosis of AA and is recommended routine examination or clinical Volume 5 Issue 1 2018