MODIFIED ALVARADO SCORE IN CHILDREN WITH DIAGNOSIS OF APPENDICITIS

PEYVASTEH, Mehran; ASKARPOUR, Shahnam; JAVAHERIZADEH, Hazhir; BESHARATI, Sepideh

doi:10.1590/0102-6720201700010014

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Original Article • ABCD, arq. bras. cir. dig. 30 (1) • Jan-Mar 2017 • https://doi.org/10.1590/0102-6720201700010014 linkcopy

MODIFIED ALVARADO SCORE IN CHILDREN WITH DIAGNOSIS OF APPENDICITIS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background: Appendicitis is one of the most common abdominal emergency. Some predictive scoring systems are recommended to decrease the rate of negative appendectomy.

Aim: To evaluate sensitivity, specificity, positive predictive value, and negative predictive value of modified Alvarado score in children who underwent appendectomy.

Methods: Four hundred children with initial diagnosis of appendicitis were randomly selected from patients who underwent appendectomy. Modified Alvarado score was used for evaluation of the appendicitis, that was confirmed using histology.

Results: Of modified Alvarado score components, anorexia; nausea and vomiting and rebound tenderness were significantly more common in children with positive appendectomy in contrast to patients with negative appendectomy. Sensitivity, specificity, positive predictive value, and negative predictive value for modified Alvarado score were: 91.3%; 38.4%; 87.7%; and 51.2% respectively.

Conclusion: Alvarado score has high sensitivity but low specificity for diagnosis of acute appendicitis in children.

HEADINGS - Appendicitis; Nausea; Appendectomy.

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[TFN1] PPV=positive predictive value; NPV=negative predictive value; MAS=modified Alvarado score system

Migratory right iliac fossa pain	1
Anorexia	1
Nausea and vomiting	1
Tenderness of right lower quadrant	2
Rebound tenderness of right iliac fossa	1
Elevated temperature	1
Leukocytosis	2
Modified Alvarado Score	9

		Appendicitis(+)	Appendicitis(-)	P value
Shifting pain	Yes	218(64.7%)	15(23.8%)	0.1
Shifting pain	No	119(35.3%)	48(76.2%)	0.1
Anorexia	Yes	248(73.6%)	32(50.8%)	<0.001
Anorexia	No	89(26.4%)	31(49.2%)	<0.001
Nausea and vomiting	Yes	284(84.3%)	38(60.3%)	<0.001
Nausea and vomiting	No	53(15.7%)	25(39.7%)	<0.001
RLQ Pain	Yes	308(91.4%)	41(65.1%)	0.3
RLQ Pain	No	29(8.6%)	22(34.9%)	0.3
Rebound tenderness	Yes	195(57.9%)	19(30.2%)	<0.001
Rebound tenderness	No	142(42.1%)	44(69.8%)	<0.001
Fever	Yes	166(49.3%)	27(42.9%)	0.4
Fever	No	171(50.7%)	36(57.1%)	0.4
Leukocytosis	Yes	301(89.3%)	26(41.3%)	0.1
Leukocytosis	No	36(10.7%)	37(58.7%)	0.1

	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)
Migratory right iliac fossa pain	93.5	28.7	46.4	23.8
Anorexia	88.5	25.8	73.5	50.7
Nausea and vomiting	88.1	32.1	84.2	11.2
RLQ tenderness	88.2	43.1	91.3	65.1
Rebound tenderness	91.1	23.6	57.8	30.1
Fever	85.9	17.3	49.2	42.8
Leukocytosis	92.1	50.6	89.3	41.2
MAS	91.3	38.4	87.7	51.2

Alvarado score	Appendicitis(+)	Appendicitis(-)
1-4	3(0.9%)	45(71.4%)
5-6	104(30.9%)	18(28.6%)
7-9	230(68.2%)	0