USE OF THE ALVARADO SCORE IN SUSPECTED ACUTE APPENDICITIS
Keywords:
alvarado score appendicitis ripasa
Abstract
INTRODUCTION/OBJECTIVE Appendicitis is an inflammation of the appendix,with the appearance of symptoms in the first 24 hours.Clinically,it presents with pain in the abdomen,most often in the lower right quadrant,increased temperature,loss of appetite,nausea and vomiting.Due to the non-specificity of symptoms,scoring systems have been developed to facilitate diagnostic of suspected appendicitis.Objective is the use of the Alvarado score at the prehospital level in case of suspected acute appendicitis.CASE REPORT The Department of Emergency Medicine in Belgrade was sent a call for intervention due to abdominal pain.The periumbilical pain started last night,she had fever and nausea.Alvarado score was 6, the patient was transported to the ER where the diagnosis of acute appendicitis was confirmed.CONCLUSION Prehospital diagnostics of acute appendicitis is based on history and physical examination,where use of the Alvarado score can be very important,with the aim of reducing the risk of complications,morbidity and mortality.KEY WORDS alvarado, scabies, appendicitis, ripasa
References
1. Lotfollahzadeh S, Lopez RA, Deppen JG. Appendicitis. 2024 Feb 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 29630245.
2. Snyder MJ, Guthrie M, Cagle S. Acute Appendicitis: Efficient Diagnosis and Management. Am Fam Physician. 2018 Jul 1;98(1):25-33. PMID: 30215950.
3. Téoule P, Laffolie J, Rolle U, Reissfelder C. Acute Appendicitis in Childhood and Adulthood. DtschArztebl Int. 2020 Nov 6;117(45):764-774. doi: 10.3238/arztebl.2020.0764. PMID: 33533331; PMCID: PMC7898047.
4. Awayshih MMA, Nofal MN, Yousef AJ. Evaluation of Alvarado score in diagnosing acute appendicitis. Pan Afr Med J. 2019 Sep 6;34:15. doi: 10.11604/pamj.2019.34.15.17803. PMID: 31762884; PMCID: PMC6859007.
5. Frountzas M, Stergios K, Kopsini D, Schizas D, Kontzoglou K, Toutouzas K. Alvarado or RIPASA score for diagnosis of acute appendicitis? A meta-analysis of randomized trials. Int J Surg. 2018 Aug;56:307-314. doi: 10.1016/j.ijsu.2018.07.003. Epub 2018 Jul 12. PMID: 30017607.
6. Andersson, R.E., Stark, J. Diagnostic value of the appendicitis inflammatory response (AIR) score. A systematic review and meta-analysis. World J EmergSurg 20, 12 (2025). https://doi.org/10.1186/s13017-025-00582-x
7. Chisthi MM, Surendran A, Narayanan JT. RIPASA and air scoring systems are superior to alvarado scoring in acute appendicitis: Diagnostic accuracy study. Ann Med Surg (Lond). 2020 Sep 24;59:138-142. doi: 10.1016/j.amsu.2020.09.029. PMID: 33024555; PMCID: PMC7527659.
8. Mehbub H, Baig AA, Khalid R, Mehmood MS, Ur Rehman O, Ghani U, Ahmad A. A Comparison of the Modified Alvarado Score and the Raja IsteriPengiranAnakSaleha Appendicitis (Ripasa) Score in a Southeast Asian Population With Histopathology as the Gold Standard. Cureus. 2023 Oct 9;15(10):e46715. doi: 10.7759/cureus.46715. PMID: 38021985; PMCID: PMC10630786.
9. Favara G, Maugeri A, Barchitta M, Ventura A, Basile G, Agodi A. Comparison of RIPASA and ALVARADO scores for risk assessment of acute appendicitis: A systematic review and meta-analysis. PLoS One. 2022 Sep 30;17(9):e0275427. doi: 10.1371/journal.pone.0275427. PMID: 36178953; PMCID: PMC9524677.
10. Zeb M, Khattak SK, Samad M, Shah SS, Shah SQA, Haseeb A. Comparison of Alvarado score, appendicitis inflammatory response score (AIR) and Raja IsteriPengiranAnakSaleha appendicitis (RIPASA) score in predicting acute appendicitis. Heliyon. 2023 Jan 16;9(1):e13013. doi: 10.1016/j.heliyon.2023.e13013. PMID: 36711320; PMCID: PMC9876948.
11. Inteti K, Shaik MR, Ganapa P, Gandi PS. A Comparison of the Alvarado Score and the Raja IsteriPengiranAnakSaleha Appendicitis (RIPASA) Score in the Diagnosis of Acute Appendicitis: A Prospective Cohort Study. Cureus. 2024 Aug 28;16(8):e68041. doi: 10.7759/cureus.68041. PMID: 39347188; PMCID: PMC11433655.
12. Tchoumi, Josianne1; Gruden, Enrico2; Elenga, Narcisse3; Kayemba-Kay’s, Simon4. Modified Alvarado and Samuel scores: Contribution to the diagnosis of acute appendicitis in the pediatric acute and emergency department. International Journal of Pediatrics and Adolescent Medicine 10(3):p 59-64, September 2023. | DOI: 10.4103/ijpam.ijpam_6_24
13. Pogorelić Z, Rak S, Mrklić I, Jurić I. Prospective validation of Alvarado score and Pediatric Appendicitis Score for the diagnosis of acute appendicitis in children. PediatrEmerg Care. 2015 Mar;31(3):164-8. doi: 10.1097/PEC.0000000000000375. PMID: 25706925.
14. Gebreselassie H, Zeleke H, Ashebir D. Diagnosis of Acute Appendicitis: A Cross-sectional Study on Alvarado's Score from a Low Income Country. Open Access Emerg Med. 2023 Jun 16;15:253-258. doi: 10.2147/OAEM.S410119. PMID: 37346382; PMCID: PMC10281270.
15. Sultana Z, Ali G, Nawaz H, Ali J, Ahmed A, Ali A, Tahir M, Jan Y. Accuracy of the Raja IsteriPengiranAnakSaleha Appendicitis (RIPASA) and Alvarado Score for Acute Appendicitis: A Comparative Study. Cureus. 2025 Oct 3;17(10):e93756. doi: 10.7759/cureus.93756. PMID: 41189820; PMCID: PMC12582032.
16. Mariage M, Sabbagh C, Grelpois G, Prevot F, Darmon I, Regimbeau JM. Surgeon's Definition of Complicated Appendicitis: A Prospective Video Survey Study. Euroasian J Hepatogastroenterol. 2019 Jan-Jun;9(1):1-4. doi: 10.5005/jp-journals-10018-1286. PMID: 31988858; PMCID: PMC6969325.
2. Snyder MJ, Guthrie M, Cagle S. Acute Appendicitis: Efficient Diagnosis and Management. Am Fam Physician. 2018 Jul 1;98(1):25-33. PMID: 30215950.
3. Téoule P, Laffolie J, Rolle U, Reissfelder C. Acute Appendicitis in Childhood and Adulthood. DtschArztebl Int. 2020 Nov 6;117(45):764-774. doi: 10.3238/arztebl.2020.0764. PMID: 33533331; PMCID: PMC7898047.
4. Awayshih MMA, Nofal MN, Yousef AJ. Evaluation of Alvarado score in diagnosing acute appendicitis. Pan Afr Med J. 2019 Sep 6;34:15. doi: 10.11604/pamj.2019.34.15.17803. PMID: 31762884; PMCID: PMC6859007.
5. Frountzas M, Stergios K, Kopsini D, Schizas D, Kontzoglou K, Toutouzas K. Alvarado or RIPASA score for diagnosis of acute appendicitis? A meta-analysis of randomized trials. Int J Surg. 2018 Aug;56:307-314. doi: 10.1016/j.ijsu.2018.07.003. Epub 2018 Jul 12. PMID: 30017607.
6. Andersson, R.E., Stark, J. Diagnostic value of the appendicitis inflammatory response (AIR) score. A systematic review and meta-analysis. World J EmergSurg 20, 12 (2025). https://doi.org/10.1186/s13017-025-00582-x
7. Chisthi MM, Surendran A, Narayanan JT. RIPASA and air scoring systems are superior to alvarado scoring in acute appendicitis: Diagnostic accuracy study. Ann Med Surg (Lond). 2020 Sep 24;59:138-142. doi: 10.1016/j.amsu.2020.09.029. PMID: 33024555; PMCID: PMC7527659.
8. Mehbub H, Baig AA, Khalid R, Mehmood MS, Ur Rehman O, Ghani U, Ahmad A. A Comparison of the Modified Alvarado Score and the Raja IsteriPengiranAnakSaleha Appendicitis (Ripasa) Score in a Southeast Asian Population With Histopathology as the Gold Standard. Cureus. 2023 Oct 9;15(10):e46715. doi: 10.7759/cureus.46715. PMID: 38021985; PMCID: PMC10630786.
9. Favara G, Maugeri A, Barchitta M, Ventura A, Basile G, Agodi A. Comparison of RIPASA and ALVARADO scores for risk assessment of acute appendicitis: A systematic review and meta-analysis. PLoS One. 2022 Sep 30;17(9):e0275427. doi: 10.1371/journal.pone.0275427. PMID: 36178953; PMCID: PMC9524677.
10. Zeb M, Khattak SK, Samad M, Shah SS, Shah SQA, Haseeb A. Comparison of Alvarado score, appendicitis inflammatory response score (AIR) and Raja IsteriPengiranAnakSaleha appendicitis (RIPASA) score in predicting acute appendicitis. Heliyon. 2023 Jan 16;9(1):e13013. doi: 10.1016/j.heliyon.2023.e13013. PMID: 36711320; PMCID: PMC9876948.
11. Inteti K, Shaik MR, Ganapa P, Gandi PS. A Comparison of the Alvarado Score and the Raja IsteriPengiranAnakSaleha Appendicitis (RIPASA) Score in the Diagnosis of Acute Appendicitis: A Prospective Cohort Study. Cureus. 2024 Aug 28;16(8):e68041. doi: 10.7759/cureus.68041. PMID: 39347188; PMCID: PMC11433655.
12. Tchoumi, Josianne1; Gruden, Enrico2; Elenga, Narcisse3; Kayemba-Kay’s, Simon4. Modified Alvarado and Samuel scores: Contribution to the diagnosis of acute appendicitis in the pediatric acute and emergency department. International Journal of Pediatrics and Adolescent Medicine 10(3):p 59-64, September 2023. | DOI: 10.4103/ijpam.ijpam_6_24
13. Pogorelić Z, Rak S, Mrklić I, Jurić I. Prospective validation of Alvarado score and Pediatric Appendicitis Score for the diagnosis of acute appendicitis in children. PediatrEmerg Care. 2015 Mar;31(3):164-8. doi: 10.1097/PEC.0000000000000375. PMID: 25706925.
14. Gebreselassie H, Zeleke H, Ashebir D. Diagnosis of Acute Appendicitis: A Cross-sectional Study on Alvarado's Score from a Low Income Country. Open Access Emerg Med. 2023 Jun 16;15:253-258. doi: 10.2147/OAEM.S410119. PMID: 37346382; PMCID: PMC10281270.
15. Sultana Z, Ali G, Nawaz H, Ali J, Ahmed A, Ali A, Tahir M, Jan Y. Accuracy of the Raja IsteriPengiranAnakSaleha Appendicitis (RIPASA) and Alvarado Score for Acute Appendicitis: A Comparative Study. Cureus. 2025 Oct 3;17(10):e93756. doi: 10.7759/cureus.93756. PMID: 41189820; PMCID: PMC12582032.
16. Mariage M, Sabbagh C, Grelpois G, Prevot F, Darmon I, Regimbeau JM. Surgeon's Definition of Complicated Appendicitis: A Prospective Video Survey Study. Euroasian J Hepatogastroenterol. 2019 Jan-Jun;9(1):1-4. doi: 10.5005/jp-journals-10018-1286. PMID: 31988858; PMCID: PMC6969325.
Published
2026/02/23
Section
Case report
Autori koji objavljuju u ovom časopisu pristaju na sledeće uslove:
- Autori zadržavaju autorska prava i pružaju časopisu pravo prvog objavljivanja rada i licenciraju ga "Creative Commons Attribution licencom" koja omogućava drugima da dele rad, uz uslov navođenja autorstva i izvornog objavljivanja u ovom časopisu.
- Autori mogu izraditi zasebne, ugovorne aranžmane za neekskluzivnu distribuciju članka objavljenog u časopisu (npr. postavljanje u institucionalni repozitorijum ili objavljivanje u knjizi), uz navođenje da je članak izvorno objavljen u ovom časopisu.
- Autorima je dozvoljeno i podstiču se da postave objavljeni članak onlajn (npr. u institucionalni repozitorijum ili na svoju internet stranicu) pre ili tokom postupka prijave rukopisa, s obzirom da takav postupak može voditi produktivnoj razmeni ideja i ranijoj i većoj citiranosti objavljenog članka (Vidi Efekti otvorenog pristupa).