Article Text

Download PDFPDF

Validity of Alvarado Score in predicting disease severity and postoperative complication in pediatric acute appendicitis
  1. Patrick H Y Chung1,2,
  2. Kanglin Dai2,
  3. Zhen Yang2 and
  4. Kenneth K Y Wong1,2
  1. 1 Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
  2. 2 Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
  1. Correspondence to Dr Kenneth K Y Wong; kkywong{at}


Background This study evaluates the validity of Alvarado Score in predicting disease severity and the development of postoperative complications in pediatric appendicitis.

Methods This is a retrospective, bicentered study on pediatric patients with emergency appendicectomy performed from 2006 to 2016. The relationship of Alvarado Score (low: 1–4, medium: 5–6, high: 7–10) and operative findings/complications was analyzed.

Results A total of 316 patients were included and the median age on admission was 10.8 years. The overall median score was 8.0. 13.3%, 20.2%, and 66.5% of patients had low, medium, and high risk scores, respectively. 36.1% of patients had complicated appendicitis and the median score was comparable with that of the uncomplicated cases (7.0 vs 7.4, p=0.21). More complicated cases were found in the medium-risk group (high vs medium vs low=29.7% vs 61.4% vs 31.0%, p=0.01). Rebound tenderness had the highest positive predictive value (65%) for complicated appendicitis. Postoperative complications were found in 16.5% of patients with a higher median score (7.87 vs 5.8, p=0.01).

Conclusion Alvarado Score does not predict disease severity but postoperative complication. Patients with medium risk score should also be treated promptly for the risk of having complicated disease. Rebound tenderness may be a signal for complicated appendicitis and should be properly examined.

  • appendicits
  • alvarado
  • complications

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors PHYC conceived and designed the study. ZY and KD collected the data. KKYW supervised the study and advised on the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study has been approved by the hospital ethics committee and was done in accordance with the principles outlined in the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors welcome sharing of data from the study.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.