ALVARADO SCALE: CRITERIA AND DIAGNOSIS FOR APPENDICITIS - MEDICINE - 2025

The Alvarado scale is a clinical scoring system used for the diagnosis of acute appendicitis. The scale is based on the symptoms, signs and laboratory tests that are used in the diagnostic approach of a patient with abdominal pain in whom the diagnosis of acute appendicitis is suspected.

Acute appendicitis is the main cause of infection of the appendix and can lead to serious complications when it is not treated in time. For this reason it is important to diagnose the disease as soon as possible.

By Darko Djurin (https://pixabay.com/en/users/derneuemann-6406309/) - https://pixabay.com/es/abdominal-pain-pain-la-apendicitis-2821941/ archive copy at the Wayback Machine (archived on 18 January 2019), CC0, Scoring scales such as Alvarado's have proven to be very useful when corroborating the diagnosis of a patient in whom there is a suspicion that he may be suffering from acute appendicitis.

Predictive scales for acute appendicitis

In initial stages, the symptoms of appendicitis are very nonspecific and can be confused with other types of pathologies. Some people don't even realize the discomfort caused by this medical condition.

There are several scoring scales that seek to diagnose an acute appendicitis from its initial stage.

In 1986, Dr. Alfredo Alvarado described a clinical scoring system for the diagnosis of acute appendicitis in his work A practical Score for the early diagnosis of acute appendicitis. This system is based on symptoms and simple laboratory tests.

However, a modification has been made for precarious health centers that do not have the possibility of performing laboratory tests. The modification consists of removing this criterion from the scale and lowering the score.

The Alvarado scale: criteria

The Alvarado scale, also called MANTRELS, is based on three symptoms, three clinical signs, and two laboratory tests. These parameters are assigned a score for a total of 10 points.

The parameters and scores for each are as follows:

A score of 4 supposes a low risk of appendicitis, between 5 and 7 is compatible with an intermediate risk, after 8 the patient enters the high-risk group and is considered a criterion for taking the patient to the operating room.

The value of the Alvarado scale is that it is a simple method that can establish a diagnosis of acute appendicitis without the need for other diagnostic tests.

Currently, the Alvarado scale has been compared with other more complex scales, such as the Asian RIPASA scale, which involves more parameters than the previous one for a total of 12 points. However, no significant differences were found between the two scales.

In the case of the Alvarado scale, it has been shown that its function is more adequate to rule out the process of appendicitis than to diagnose it.

This means that when a patient presents in the low risk group (4 points or less on the scale) there is a high probability that that patient does not have the disease. However patients in the high risk group (8 or more points on the scale) may not have appendicitis.

Modified Alvarado scale

There are two modifications of the Alvarado scale for the diagnosis of acute appendicitis.

The first one excludes laboratory values ​​from the scale. This is done because there are remote health centers, which do not have the possibility of performing this type of exams.

The scale is also used by subtracting these parameters. However, the modified scale does not have the same diagnostic value as the original scale and fails to diagnose early stages of the inflammatory process.

The pediatric appendicitis scale (PAS) described by Samuel in 2002, is also a modification of the Alvarado scale oriented to the pediatric area.

In this case, the rebound sign is changed to pain when coughing, sneezing, or jumping, and the fever parameter rises to 38 ° C, with 37.3 ° C on the original scale.

The rest of the scales for the diagnosis of acute appendicitis are less well known and are not widely used due to their complexity or the need for diagnostic tests that are not always accessible in all health centers, such as ultrasound or computerized axial tomography.

Acute appendicitis

Acute appendicitis is one of the main causes of acute surgical abdomen. This means that it is one of the main diseases of the abdomen for which a patient must undergo emergency surgery.

The appendicitis process occurs relatively quickly, the box can be fully installed in 6 to 8 hours and become very dangerous from that moment. Complications range from peritonitis, contamination of the abdominal cavity to blood infection, called sepsis, and even death.

By Davalos - Embryology and Genetics. Second edition. Editorial Ofnin. La Paz. 1990, CC BY-SA 4.0, The cases of death from acute appendicitis decreased dramatically from 1950 with the arrival of more powerful antibiotics. However, in remote places without access to adequate medications it is more common to see these types of complications.

Diagnosis

The diagnosis of acute appendicitis is basically clinical. In other words, it is based in large part on the questioning of the patient, the abdominal physical examination and the blood tests presented.

Although a fully installed picture of acute appendicitis is easy to diagnose, the challenge is to detect the earliest cases so that it can be treated surgically as soon as possible.

By Darko Djurin (https://pixabay.com/en/users/derneuemann-6406309/) - https://pixabay.com/es/abdominal-pain-pain-la-apendicitis-2821941/ archive copy at the Wayback Machine (archived on 18 January 2019), CC0, The sequence in which the symptoms have been presenting is of utmost importance. The doctor must be meticulous and insistent when it comes to questioning in order to organize this sequence and try to reach the diagnosis.

The treatment of acute appendicitis is the surgical removal of the organ, a procedure called appendectomy. However, in approximately 20% of surgeries the final biopsy reveals a completely healthy appendix.

References

1. by Quesada Suárez, Leopoldo; Ival Pelayo, Milagros; González Meriño; Charity Lourdes. (2015). The Alvarado scale as a clinical resource for the diagnosis of acute appendicitis. Cuban Journal of Surgery. Taken from: scielo.sld.cu
2. Chung, PHY; Dai K, Yang Z; et al. (2019). Validity of Alvarado Score in predicting disease severity and postoperative complication in pediatric acute appendicitis. World Journal of Pediatric Surgery Taken from: bmj.com
3. Kabiri, A. R; Nejad, FF (2015) Evaluation of Alvarado Score in Acute Appendicitis Patients Hospitalized in the Emergency Department of A Hospital During 2008- 2009. Biomed Pharmacol J. 2015; 8 (2)
4. Ohle, R; O'Reilly, F; O'Brien, K. K; Fahey, T; Dimitrov, BD (2011). The Alvarado score for predicting acute appendicitis: a systematic review. BMC medicine. Taken from: ncbi.nlm.nih.gov
5. Özsoy, Z., & Yenidoğan, E. (2017). Evaluation of the Alvarado scoring system in the management of acute appendicitis. Turkish journal of surgery. Taken from: ncbi.nlm.nih.gov
6. Alvarado, A. (2018). Diagnostic Scores in Acute Appendicitis, Current Issues in the Diagnostics and Treatment of Acute Appendicitis. Taken from: intechopen.com