Alvarado score as an admission criterion in children with pain in right iliac fossa.
BACKGROUND
Acute appendicitis is an important differential diagnosis in children with pain in the right iliac fossa. Some patients have equivocal signs that make the diagnosis difficult. Many patients with suspected acute appendicitis are admitted for observation and finally discharged because they did not have appendicitis. We decided to design this study to investigate whether the Alvarado score could be used by emergency room doctors as a criterion for admission to hospital.


METHODS
This is a prospective study comprising 350 patients who attended the emergency department with suspected acute appendicitis in the period from May 2007 to April 2009. All patients were scored by Alvarado score in the emergency department before admission. The Alvarado score is based on three symptoms, three signs and two laboratory findings. The decision for admission and surgery was made independent of the score. The diagnosis of patients who underwent appendicectomy was confirmed by both operative findings and postoperative histopathology.


RESULTS
We studied the Alvarado scores of 350 patients who presented to the emergency department with pain in the right iliac fossa; their age ranged from 8 to 14 years; 182 patients (52%) operated with the aim to treat acute appendicitis, 168 patients (48%) were discharged without surgical intervention and advised to attend the out-patient clinic after 24 hours for re-evaluation. we have found that patients with a low Alvarado score (less than 6) did not have acute appendicitis.


CONCLUSIONS
Patients with equivocal signs can present a diagnostic challenge and are very often admitted to the surgical department for observation. The Alvarado score can be used as a scoring system that help in taking the decision for admission of cases with suspected acute appendicitis especially by primary healthcare providers.
Shreef
Khalid S
KS
Department of Pediatric Surgery, Zagazig University, Egypt.
Waly
Amira Hasan
AH
Abd-Elrahman
Sarhan
S
Abd Elhafez
M A
MA
D000006:Abdomen, Acute / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D003657:Decision Making; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010343:Patient Admission / Q000592:standards* / Q000706:statistics & numerical data; D017699:Pelvic Pain / Q000175:diagnosis*; D011446:Prospective Studies; D012720:Severity of Illness Index