Background
Methods
Data sources and search strategy
Study selection
Quality assessment, data extraction and statistical analysis
Diagnostic accuracy of the Alvarado score
Calibration analysis of the Alvarado score
Results
First author, study year [reference] | Number of patients | Age (years) | Gender n | Appendicitis prevalence (%) | Country | Setting | Study type | Patient population |
---|---|---|---|---|---|---|---|---|
Abdeldaim 2007 [19] | 242 | Median 42 Range 8 to 76 | Male 90 Female 152 | 51 | Ireland | Emergency department | Retrospective | Right iliac fossa pain |
Al Qahtani 2004 [8] | 211 | Mean 32 Range 13 to 70 | Male 125 Female 86 | 57 | Saudi Arabia | Emergency department | Prospective | Suspected acute appendicitis |
Alvarado 1986 [5] | 277 | Mean 25.3 Range 4 to 80 | Male 131 Female 96 | 82 | USA | Hospital inpatients | Prospective | Abdominal pain |
Arain 2001 [20] | 100 | Mean 19.9 | Males 44 Females 56 | 48 | Pakistan | Surgical unit | Prospective | Suspected acute appendicitis |
Baidya 2007 [44] | 231 | Mean 26.3 Range 16 to 65 | Male 141 Female 90 | 52 | India | Emergency department | Prospective | Right iliac fossa pain |
Bond 1990 [21] | 187 | Range 0 to 18 | 61 | USA | Emergency department | Prospective | Abdominal pain | |
Borges 2003 [22] | 76 | Age 2 to 6 = 23 Age 7 to 10 = 38 Age > 10 = 15 | Male 40 Female 36 | 71 | Brazil | Emergency department | Prospective | Suspected acute appendicitis |
Canavosso 2008 [23] | 224 | Mean 26.65 Range 13 to 82 | Male 117 Female 10 | 84 | Argentina | Emergency department | Prospective | Right lower quadrant pain |
Chan 2001 [25] | 148 | Mean 29 Range 10 to 73 | Male 107 Female 41 | 34 | Singapore | Emergency department | Retrospective | Suspected acute appendicitis |
Chan 2003 [24] | 175 | Mean 30 Range 8 to 73 | Male 130 Female 45 | 43 | Singapore | Emergency department | Prospective | Right iliac fossa pain |
Denizbasi 2003 [45] | 221 | Mean 26.6 | Male 112 Female 109 | 79 | Turkey | Emergency department | Prospective | Abdominal pain and suspected acute appendicitis |
Escriba 2011 [42] | 99 | Mean 11.2 Range 4 to 17.8 | Male 62 Female 37 | 42 | Spain | Emergency department | Prospective | Abdominal pain/suspected appendicitis |
Farahnak 2007 [26] | 21 | - | - | 48 | Iran | Emergency department | Prospective | Abdominal pain |
Gwynn 2001 [27] | 215 | - | - | 66 | USA | Emergency department | Retrospective | Abdominal pain |
Hsiao 2005 [28] | 222 | Mean 9.4 Range 1 to 13 | Male 146 Female 76 | 50 | Taiwan | Emergency department | Retrospective | Suspected acute appendicitis |
Kang 1989 [46] | 62 | Mean 45.8 Range 18 to 78 | Male 42 Female | 68 | China | Hospital inpatients | Prospective | Suspected acute appendicitis |
Khan 2005 [29] | 100 | Mean 20.2 Range 9 to 56 | Female 59 Male 41 | 54 | Pakistan | Surgical ward | Prospective | Suspected acute appendicitis |
Kim 2006 [9] | 211 | - | - | 83 | Korea | Surgical ward | Retrospective | Suspected acute appendicitis |
Kim 2008 [18] | 157 | Mean 37.1 Range 15 to 84 | - | 57 | Korea | Emergency department | Prospective observational study | Abdominal pain |
Lada 2005 [10] | 83 | Mean 27.5 Range 15 to 75 | Male 43 Female 40 | 88 | Argentina | Emergency department | Prospective | Suspected acute appendicitis |
Malik 2000 [56] | 100 | Mean 22 Range 14 to 18 | Male 81 Female 19 | 92 | Pakistan | Surgical unit | Prospective | Suspected acute appendicitis |
McKay 2007 [31] | 150 | Mean 34 Range 18 to 76 | Male 78 Female 65 | 32 | USA | Emergency department | Retrospective | Abdominal pain |
Memon 2009 [32] | 100 | Mean age 24 Range 13 to 55 | Male 65 Female 35 | 91 | Pakistan | Surgical Ward | Prospective study | Suspected acute appendicitis |
Muenzer 2010 [47] | 28 | Test Cohort Mean 11 Validation cohort Mean 11 Range 2 to 17 | Test cohort Male 10 Female 10 Validation cohort Male 4 Female 4 | 54 | USA | Emergency department | Unclear | Abdominal pain |
Owen 1992 [11] | 215 | Male 75 Female 70 Children 70 | 58 | Wales | Emergency department | Prospective observational study | GP referral for Suspected acute appendicitis | |
Petrosyan 2008 [33] | 1,630 | Male: Median 29 yrs Range 3 to 85 yrs Female: Median 34 yrs Range 2 to 86 yrs | Male 928 Female 702 | 54 | USA | Emergency department | Retrospective | Right lower quadrant pain and suspected acute appendicitis |
Rezak 2011 [40] | 59 | Mean 8.5 Range 3 to 16 | Male 43 Female 16 | 51 | USA | Community teaching hospital | Retrospective | Suspected appendicitis |
Saidi 2000 [43] | 128 | Male 49 Female 79 | 35 | Iran | Emergency department | Prospective | Suspected acute appendicitis | |
Sanabria 2007 [34] | 374 | Mean 29.5 Range 15 to 71 | Male 178 Female 196 | 55 | Columbia | Emergency department | Prospective | Right iliac fossa pain and suspected acute appendicitis |
Schneider 2007 [12] | 588 | Median 11.9 Range 3 to 21 | 33 | USA | Emergency department | Prospective cohort | Suspected acute appendicitis | |
Shreef 2010 [41] | 350 | Mean 9.3 Range 8 to 14 | Male 228 Female 122 | 38 | Egypt, Saudi Arabia | Emergency department | Prospective | Suspected acute appendicitis |
Shrivastava 2004 [57] | 100 | Male 45 Female 30 | 78 | India | Emergency department | Prospective | Suspected acute appendicitis | |
Singh 2008 [35] | 100 | Mean 22.6 Median 25 | Male 55 Female 45 | 62 | India | Surgical Ward | Prospective | Suspected acute appendicitis |
Soomro 2008 [36] | 227 | Mean 20.47 Range 10 to 62 | Male 150 Females 77 | 55 | Pakistan | Emergency department | Prospective | Suspected acute appendicitis |
Stephens 1999 [37] | 94 | Mean 44 Range 3 to 79 | Males 46 Female 48 | 89 | USA | Surgical unit | Retrospective | All patients who underwent appendectomy for suspected acute appendicitis |
Tade 2007 [38] | 100 | Range 17 to 56 | Males 63 Female 37 | 34 | Nigeria | Emergency department | Prospective | Right iliac fossa pain and suspected acute appendicitis |
Wani 2007 [30] | 96 | Mean 25.46 Range 7 to 70 | Male 48 Female 48 | 70 | India | Surgical unit | Prospective | Suspected acute appendicitis |
Yildirim 2008 [39] | 143 | Mean 34 Range 18 to 76 | Male 78 Females 65 | 85 | Turkey | Emergency department | Prospective study | Abdominal pain |
Winn 2004 [58] | 142 | 39 | Australia | Surgical ward | Retrospective | Suspected acute appendicitis | ||
Subotic 2008 [59] | 57 | Mean 27.5 Range 16 to 70 | Male 27 Female 30 | 84 | Serbia | Emergency department | Prospective | Suspected acute appendicitis |
Andersson 2008 [60] | 229 | Mean 23 | Males 105 Females 124 | 33 | Sweden | Emergency department | Prospective | Suspected acute appendicitis |
Prabhudesai 2008 [61] | 60 | Mean 25.4 | Male 27 Female 33 | 40 | UK | Emergency department | Prospective | Suspected acute appendicitis |
Diagnostic accuracy of the Alvarado score
Studies | n | Sensitivity (95% CI) | Variance logit (sensitivity) | Specificity (95% CI) | Variance logit (specificity) | |
---|---|---|---|---|---|---|
Observation/ Admission (Cut point 5) | All studies | 28 | 0.99 (0.97 to 0.99) | 3.37 | 0.43 (0.36 to 0.51) | 0.61 |
Men | 5 | 0.96 (0.88 to 0.99) | 1.09 | 0.34 (0.24 to 0.47) | 0.06 | |
Women | 5 | 0.99 (0.92 to 0.99) | 2.12 | 0.35 (0.14 to 0.64) | 1.51 | |
Children* | 9 | 0.99 (0.83 to 1.00) | 8.99 | 0.57 (0.41 to 0.72) | 0.79 | |
Surgery (Cut point 7) | All studies | 29 | 0.82 (0.76 to 0.86) | 0.48 | 0.81 (0.76 to 0.85) | 0.46 |
Men | 6 | 0.88 (0.75 to 0.95) | 1.15 | 0.57 (0.40 to 0.73) | 0.44 | |
Women | 7 | 0.86 (0.78 to 0.92) | 0.44 | 0.73 (0.58 to 0.84) | 0.62 | |
Children* | 9 | 0.87 (0.76 to 0.93) | 0.98 | 0.76 (0.55 to 0.89) | 1.50 |