• Winson Jianhong Tan, Sanchalika Acharyya, Yaw Chong Goh, Weng Hoong Chan, Wai Keong Wong, London Lucien Ooi, and Hock Soo Ong.
• Department of General Surgery, Singapore General Hospital, Singapore. Electronic address: tanwinson156@hotmail.com.
• J. Am. Coll. Surg.. 2015 Feb 1;220(2):218-24.

BackgroundAlthough computed tomography (CT) has reduced negative appendectomy rates, its radiation risk remains a concern. We compared the performance statistics of the Alvarado Score (AS) with those of CT scan in the evaluation of suspected appendicitis, with the aim of identifying a subset of patients who will benefit from CT evaluation.Study DesignWe performed prospective data collection on 350 consecutive patients with suspected appendicitis who were evaluated with CT scans. The AS for each patient was scored at admission and correlated with eventual histology and CT findings. The sensitivity, specificity, and positive likelihood ratios were determined for various AS and for CT scan. The AS ranges that benefitted most from CT evaluation were determined by comparing the positive likelihood ratios of CT scan with each of the AS cutoff values.ResultsThe study included 134 males (38.3%) and 216 females (61.7%). The overall prevalence of appendicitis was 44.3% in the total study population; 37.5% in females and 55.2% in males. There were 168 patients (48%) who underwent surgery, with a negative appendectomy rate of 7.7%. Positive likelihood ratio of disease was significantly greater than 1 only in patients with an AS of 4 and above. An AS of 7 and above in males and 9 and above in females has a positive likelihood ratio comparable to that of CT scan.ConclusionsEvaluation by CT is beneficial mainly in patients with AS of 6 and below in males and 8 and below in females. We propose an objective management algorithm with the AS guiding subsequent evaluation.Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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