Appendicitis diagnostic scoring

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The Alvarado score is the most widely used scoring based system in making a diagnosis of appendicitis.

Diagnostic Scoring

Alvarado Score

A number of clinical and laboratory based scoring systems have been devised to assist the diagnosis of appendicitis. The most widely used is the Alvarado score:

Alvarado score

Migratory right iliac fossa pain	1 point
Anorexia	1 point
Nausea and vomiting	1 point
Right iliac fossa tenderness	2 points
Rebound tenderness	1 point
Fever	1 point
Leukocytosis	2 points
Shift to left (segmented neutrophils)	1 point
Total score	10 points

A score of 7 or more is strongly predictive of acute appendicitis.
In patients with an equivocal score of 5-6, CT scan further reduces the rate of negative appendectomy.