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.