Alvarado Score, Ultrasound, and CRP: How to Combine Them for the Most Accurate Acute Appendicitis Diagnosis

Background The aim of the current study was to investigate whether the usage of three diagnostic methods of acute appendicitis which are Alvarado score, C- reactive protein (CRP) levels and ultrasound (US) in combination improves diagnostic accuracy significantly. Patients and Methods Data were analyzed in 254 patients with suspected appendicitis who had a sonographic examination and a CRP value. The patients were classified into four groups according to both Alvarado score and US findings. US results, Alvarado score, and CRP levels were compared. Results The most specific test among three diagnostic methods was sonography. Combination of an Alvarado score higher or equal to 5, a high CRP level (≥ 0.8) and a sonographic examination as appendicitis with visualization of an inflamed or perforated appendix was more specific than US alone. An Alvarado score higher or equal to 5 (86.2%) was found to be the most sensitive criteria. Conclusions Using Alvarado score, US and CRP levels in combination provides us to confirm or rule out acute appendicitis safely.