ABCD2 Score = 0

Typically used to help rule out appendicitis, in either adults or pediatrics.

Signs
Symptoms
Labs

 

Mnemonic:

Migration
Anorexia
Nausea/Vomiting
Tenderness in RLQ (2)
Rebound pain
Elevated temperature
Leukocytosis (2)
Shift of neutrophils to the left

Pretest probability ≤ 50% & Alvarado score < 4 → probability of appendicitis 0.5% - 3% (per a systematic review cited below).

Many experts feel 3% is an acceptable miss rate for appendicitis.

A prospective randomized trial in 2013 found using a modified Alvarado score in an attempt to clinically exclude the diagnosis of appendicitis (without using pretest probability / clinical judgement) resulted in a sensitivity of only 72%.

 

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986; 15(5):557-64.

McKay R, Shepherd J. The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. Am J Emerg Med. 2007; 25(5):489-93.

Ebell, MH and Shinholser, J. What are the most clinically useful cutoffs for the Alvarado and Pediatric Appendicitis Scores? A systematic review. Ann Emerg Med. 2014; 64(4):365-372.