Original Article

The Alvarado Scoring System frunr:?fiofrsl:Er'lei6sdnrsurdsuuffu

Ca v Ica::riil:vur5nrJtauar: Sawanpracharak Medical |ournalani-ivvf,ii 0 niluii s iluslruu-fuarnru zmz Vol.o No.s September-December zoos

A det e,u1IUfi9t1{flUU

The Alvarado Scoring System for Diagnostic of Acute Appendicitis

d<io:R1 lYtfiTt:tI Yt.lJ.

I:sr,{ururaarou'r?vvdo{fi?ouFllfl?itfi

Jeerapa Phophrom M.D.

Ladyao Hospital

Nakhon Sawan

umffodo

SncrrJ:vose{

I:nl#d.:dn rau rfi suyrfiu'[ul:.,:il fl rurntil{uddrdoluYlflRul : [:{y{Er1U1AA1Ael1?

fAUaualtyu:ljlluunl:?ou : n1Tlaurz.,:Tl::6uu1rruuLilt1{?1u1ltt v t v u ia t y v t i - vy! u a vROtl9l?ou1{ : ,J1l'lUililA1n1:il?nmA{n1Ufl?1n1{ d.*r6l.,16lrjR1?sLdn.0Onr6luraUUy{nUiq

y@vof

rrasr{riunr:inur'tur:.,:?ltl1u1aa1nam ri.,:rroi 1 iln:1nil 2551 fi.,:

31 n:no1Flu 2552 siluru tgs Ftu

AA4?fiRl:flRgt : rirrrdannriuffthamrertnruq{firirmun r.iufinfrarunrdarriu o'tu Ly{Frq{sq

a1 fl 'r: 01fl 1:rrdn.,l uasrJafl lTnT?an1{fr0{rJfi uh nr: (wBC count)

ta.,: firjr a udav:1 s uasfiufi na.:tu AMarado score form lor a rirmu pr

'lfr ns uuu:? u? a.] Atvarado score rir miu nr:ifi o dal:ntfi 6.,: a-n rdudv'ia14

rquuy{nufl fl ?m3nu nsLluu&J1fl fl?1fi Tarm']riu 7 FtsLruu rrf,rrGaulfi auq

r.r a nr:i fi o a'u dlfior n nr:'lfi AMarado sco re n-u n r:i fi o fafiu a nfrr cr

A - ttyo' j 6d ' u

fr lruar nd'nuruvldfi .:fr rtiuor n nr:nlt n-or uayruafl 'l:Fn?eyt1.,:il urBiil ar

amnmf;nut : firjrudruru 1gs nu lfiiunr:nirrinrinr*r 109 nu uastfiiunr:ifloq'Elq

Aa,Ja: tfiafinurn?1ilil11fi4fia24.,: Alvarado scoring system'lunr:ifiqdtl

'i r r{l uI: nl# fi .: a n r au r d u u rq fu o r n dn uru sfi rfi u o r n n r : il r rior ura y

The Alvrado Scoring System rilnr:ifi lf,oI:nl#srl6'ntdutfi uufl d'ud,) a a

177 TheAlvaradoScoringsyst€mforDagnosticof AcuteAppendicitis flfi O afuff 3 n.E.-O.n.2552

,J n n1:n:'railfi vr fl 1Befl fl 1 1 03 nu lru"ldl':nl#fi .,: dn rau rd u uvl a'u o nuAdfu-Vhntiluan:r negative appendicectomy ToEJas 5.5 [4s41fl24fl1:

itnmsfi' v{u'j1 Alvarado scoring system fidrnrrruh (sensitivity)

faaas ffi.5 n?1ilqi1til1r (specificity)ffaaar 87.5 tmv rhnmalnrotur.lrs

fiostfizuaurnqnfra{ (positive predictive value) Saaas gs.o

?o1:6iltlasdi'q

oovnlmfla,q

Abstract

Obiective

Setting

Design

Subiects

Method

il : a1nfl1:finr*rdllu'it Alvarado scoring system fi1eJ1:6:ldleJr'lfi'Lu

nr:ifi odal:nlf; fu dn rau rdauvrd'utfi ff[ul:.,:l l a1u1a{ilf,u In u tql'{rs

riu rn rvr cieu'[m rifi ft'uT nrl:sdu n1:niLtnsn?1 eJd1u't ru'[u n1:nr?ainul

rfi a.:m n fi Fi1 n?1 ;il? tmvn?1 rJ qi1 tvrrvri al:n a',: fi r16ir a r? n t5? rl:nr tiprq

rua ctil r{l u aiu n :r er Bi a fr d r et

Atvarado score, t ^tfiai..:dn

tau tdetult#u, nr:ah riorlfi fi .:

To evaluate Alvarado scoring system in diagnosis of acute appendicitis

in community hospital.

Department of surgery, Ladyao Hospital

Prospective descriptive study

All patients with right iliac fossa pain who came to surgery department,

Ladyao Hospital during 1"t January 2008 to 31"' July 2009

Patients data including age, sex, symptoms, signs and CBC finding

were recorded in Alvarado score form. For diagnosis of acute appendicitis

to be made. Alvarado score must be equalto or more than 7. The clinical

diagnosis was made by operative and histopathology finding. Then, the

diagnosis based on Alvarodo scoring was compared to clinical diagnosis

One hundred and thirty five patients in study group, one hundred and nine

patients (80.7"/.) undenruent appendicectomies, of which six patients (5.5%)

had normal appendices on operative flnding and histopathology examination.

Overall the Alvarado scoring system showed a sensitivity of 83.5%, a

specificity of 87.5"/" and a positive predictive value of 95.6%

Results

d, v €d?T:nil:vt1:nut?{d1: O:R'I I?Tfi1I:TT 178

Conclusion :

Key words :

The Alvarado scoring system is found to be helpful in the diagnosis

and management of acute appendicitis, especially for junior surgeons.

This scoring system is easy to use, cheap , practical and non invasive.

Alvarado score, Acute appendicitis, Appendicectomy

uYtlilr u.l v1:rrldfi .rd'nLdu rdaunfu (acute

appendicitis; rfllul:nnr.: rYasn::rufi ilutfiilau

Ae a 6system tJ1 LtA:.1 [Um1',]nAUn

I:.:ln{ ur ur a ar or arr t{luI:{Tr Er1 u1 a\va t v v i 6l I ia 5'r O ' 6' 6' 6l ,A-

unr.Lotiunr:ilrnrn5nurrulnfldFrLuLT{TIEr1u1a t}J{u11tJLtl{?1u6{?u LfiAltUuttflYluou Lfi[,lvlth]cq

ia

(wBC count) drunt:m:ro fir et tnta.lfi a6u .1

u r XX tu v | % | d o O{il{u n'r:ifiaa'ai:rrfifiuaEin'un1:q'nil:s{6 a1nil:vctunr:rriuavnrrruriruT ru [un1:nr?aqq

I e ra% aa sf 'qVA - d v o

nT?ai1{n1u Lravfl1:m:?am1{?1a{uOurlfl1: xuaauL:FlLrlFl{aflt6lutQuuTlau n1Tu1m:fl.oila

tuiu uttrasound mta cr scan riufinot'[firf;io

si'r rfll u ryi 1 fu rfi a.: or n fi :1 n'r rrhr LLn sdu url 6 a.:

n?1 8.J fi n1"r ar or'[u nr:ifi qd'a uasnrr rurirnr'lu

nminur rilurvr 4lfrrfi ornr?sufl :nfraurir.: 1 t6q

u Ao - d, ufl 1',lv[Ln:fl {oum d1 n 6u tLnstil u au n:1 EJ 3J1 fl

tdud nr:unnmsaflo{1#fi.:dnrau firovrfiuc

dn:rnrsuavm?\?\afl1?{qrn tatlnc t riluq

tauav e.s(')'luflo1r-iufimaru scoring systemq

-hq, o aa ul uvA v d vvr [tt?Er [ufl 1:']uaaEJ [:n Ldn{ontdu Lauuilau

uns Alvarado scoring system fitilu scoring&tv- J ov,

system m LtflUOUl{Lty,l:}141U tuo{Q1fl Ltfl U

d , u d a &a:? Fr t:? Lta sil:s?l u Fl il fi a1 fl fl 1: Flfl l*1Yt il Lu Ltae

rirtil:stmafi ltu'jr Alvarado scoring systemd,Aavii nerruiltfiafi a Bacldil:slasriennlnfl drfl nn

nxler fi nv{ar rr'[unr:ifi qdrl uasa nn1?s[Lmrnv t t v14v Js-{auar n nr:air n or rirffrlfi fl .-rl:.,:vr fl ru1 a d? u

'lu rglurJ:rrn fllm flIrr a ray'nslr.ov'r Er1u1 a{il{ud uu il 9d o

?tulntdnu{LeJLoiln1?ut Alvarado scoring

i, , OY d { r dr vyr.]1flFtanl:LU T?ALT? LiltilUAUn:1fl LtAt

tild'uu-l6a{ri'r'lfiqirer6a Alvarado scoring

system rur'lfiuiio rfi il nx1 sJ n nfia.: ueiutiT'[uAA u a r 6r ,l d

n1:'tuafl fl a{u1ast!uLI:sLutu L[ac6l1eJ1:6]

riren'lfi uilurndo.,:fi arl:sqirld fi5{u6.,:aulo'lu

nr:finultJazannt:dl nVaraOo scoring systemoe a o i*

il1 L{A:{ LUvrl{ nAUnn [:{fl fl 1U1AA1n U'r?j

rfi ad:vrfi urirntrruhlsensitivity) nxleJo,iQ1ril1s (specificity) uasnln'l13Jn1nfiil1uvr

ovlfi runur n n n fra.-: (positive predictive val ue)

?to{ Alvarado score fi nsuuu:rruMnn'i1fi64t v O aa vl Vyol v d u

rll',rfl u 7 Lunffi?uaafl L:Ft LrlFl{afl rdu rafl uyrau

a44?fiR1lflflu1

r{l u nr: fi n r*ri {B r3.,r fl T:ruu1 uu u

hlflrmarir lor a nr::ru:r rufl0ru a frda e.r'[u

auitot[T\:y'l U1U1 A A1 n U1?Yl{fi el nm8'Jl O? fl A1 n1:

,vvtU'il?nila.0Ft'rufl?1a1{ Ft.0url 1 3Jn11nil 2551

fi.,r gt nrn41nil 2ss2 f,aryad:ru:ra.r1fiuri

The Alvrado Scoring System rilnr:?fi ofiuI:nl#er'{o'nr alrfiolufiu179 TheAlviladoscoringsystemforDiagnosticof AcuteAppendiciti. fld O qfud 3 n.E.-f,.n.2552

tv{F[ a1u 41fl'l: 41fl1:Lt6lFh: LLav,{an1:m:?Q (sensitivity) n?1&tli1r?r{1r(specificity) LLns

mrtfra.,:rJfrffinr: (WBC count) uaru-ufin

at'[u Atvarado scoring Form(') (grJi4 ry ioruY\ O 4 qyu a Aryu? fl m n nu [un1TF[nu1as LFTTU n1:A61J,l U n.1{q

S- q,, iaLFI El rJU?ElylL, nytLuu:?3J 7 -1 0 ns[[uuq

6t t Alyu aa u t d, I vqlru u fl a aJ n LFIrL n1:e fi a a-fl'i1 rfl uI: nt#fi rv A u vl yu t a v

a n tdu ta uuTt au uas LBr:u nr:air n n:fl u,teh Aarirhsfifinv[uur?l.t s-6 nyLruu r{lunrie.rfiqqv qv s- J @filiuaulr{1\ u1u1n rfiaa'.,: rn na1n1:'[u

24 dder.r lor afi nr:rj:srfi ua1fl lrLrnsnsruu

Fr?1 aJ n1 nfi tJr afi oytfi ruaU? nn n fra.t (positive

predictive value) ?O.t Alvarado score

UftLu?Yt1 { fl 1:n ua:nu1 tT nn fl nuqq ruan15flnu1

rLu?yr1{ fl 1:n ua in ur rirjr u ttil.,] rilu v\ & o a 3ootJll? Um\:?1 tJ n LU n1:HnU1U tJA1U?Uq

135 nu rfluma 56 nu firt.,: zg nu alElI

t dr I dt y

Tvfi?'t{ 9-72il f,?{018j 15-29 n lnluSoaay

4O.O (n1fl.tfi t; unvnv[uu:?ilfla{ Alvaradoa, & , !

score vrufirirn-.rrrri g-tO nrrruu (n1:1.1fi 2)en Aazuu?Eimilnsuuu 1-4 nstLuu a1u?uq

3 nriruntrunvuuu:?tJflo.,t Alvarado score

'r9 Flu tu.irurudfirirlau o nu naiusJln:?a

&fl, zq "fihluo fia EJ ar nr:ilr orfr a.,: rur n{u un y

:rruqi'rnn l4-6"i'rtru,g firarnr:ilrBrfia.:rflu ltufinvrtuu:rru#',rrrd z nsrruu{utrJ d.:frrhet& - v | \ev I v. ^4--.q- , a , v l yt{ g nU Ft{fl41?Lrt:Ufl1Tzu1mn[UArifiqdu

3J1 fl?ru?l:A nyUUU??3J3J1fl fl ?1m:Ary]1 fl 1t 7,Yv aa - a, UyA v d

0v Lo:u fl 1T?uaa fl tilu L6t0ht a fl r6tu Lf, gul^l au rfl uI: rrlfi fi .: #n rau rfi a u vl aiu rirh Er fi fi n s uru u-"

5-o Ffvrruu ,iruru 26 Au vi.,:raruorfut{uautleu r uyqal tv aX auns LnTU fl 1:r,11 Fl Ft [dFh] LrFt 6t1 a1 n1Tntsumsa

I:.,:narurarfi af.:tnno1n1:'[u z+ drlru.rnsruut?&rn nn{ ffdr aoyldiu ri.r uusrir{J u l ltso' u d

[fl rJ? fl u 01 fl 't??o.] [Tn 166.:a n rau tiluuy{auY{U?1EJU?Uqillu?1DJ1l2U 10 nuilAln1:aqu{.taufu1fllfq qo

v I Yh d

flnuu1u ilu?flon 1 6 nufi arrnalrnfra.,rurn{uq

aa8anu8Ja1n1:a?ua

d ooa{aufulFl []1

OY v Y \yyt, AatLasa!6u1Fl Lfi nauulu Ln rJil?fl m3J nsuuu:.]3JI u o -------

unsy{ufi nsuuu:':r.r#.,: rrri 7 Fts[Luu{u1il1 -4 nsLruu rilunrirudtdiu ri.r uuyrirrfi arrYuq

l- t!e?A u I ua1 n1:1 0{ L:n Ldn{ a n tdu raEJUyr au5r ru num-r

d1rfi qza{01n1:il?nduiarufira [Lnyoufrlnq -'a-o5ly u 9 \V y o6a Y"lfi

n nurlruld yriaru uruydr'Lfierr n:aoqir'lu

4!y@ , uIgza' aa uQ{ LFI:Ufl1:r{1Fln Ldn{ zuan1TiIaaflfi a{n1:

i'u n-n}l rat a rru' a fi a r nr :r-h or r{a.: ru r n {urn ri'.: o'r n u&u {i o-a dt zu n nr :i fi o d'fl dtfi

o1nn1Til:yrfiufiaEl Alvarado score tunauef

Lt:niulnU positive result flo\: scorelffncuuutArv

sJlnn'i1fi5arriT ri'u 7 nrruu alrriliflurfiflil9' aa - & v Au v unu,{ a fl lT',luaaEI?udFtytl 87l Ioa1 na nu6urvrzl i , vLdn{7rytua1 fl n1 T ni1 Ft Ft Un3'{ A fl 1:nT?Am1{

4a '{ ezl J?\ fl 16Tm EJ1'ua.-:ldfi .,: rfi ail:srfi u rir nrutr

I v d, r csir.ir n nylu rtlui:nidfi tdn rdu rfi fl ur,{#u I 4 nuq--_o--

^"tt r d u yot

[u01 u? uu LsJytu?1 &t fl 1 :[tFt fl mya? a{ Ldn{

rtnsvlut#4.,:ilnfi(normat appendix) 2 nuv I u ei f

m ai.,: nr :dr oTor lirjr a n't 2 n u 01 fl 1:il a n fra,,: a or

-y- o - t

v h iaUAUA\: A\:?fl1*'lFl'l&101fl1: ryilrAfi ilnvUUU

:?sJmnn'hutoMrriu 7 nrLruu siruau 90 nu& \yu I v aa u v

Yhlfi ilFt LFTTU fl 1Tr{1 Ft Ft zunn1T1uafl uila{fl 1?

nirn-nnu'ir rides 86 nurflul:n1#6.:fnuaut o o

t J avvitFtu[u01u?uu1\uilLdFt{unnnsa 10 nu

tu n { ru {rJr Hfl sildiu nr:ifi o o-a.jr rfl uI:nl#fi r dn uau w u r{l u rirl#ndu #u 6 ntussusceprion

d, u ddx::nilTr{1ffld,t?td1T 6:nr llrdu:ru 1BO

of terminal ileum) 1 nu g.t1i1it1dflr.:zrr

unn(ruptured ovarian cyst) 2 nu uarrirlff[uqj9 f r. v

FlaunU LU{y{a{a fl tdu (caecal diverticulitis)& ' uuA1 nu n{ 4 nuy{U?1Ldn.tilnn(normal

jappendix) (n1T1.:Yl 3)

6.:d'n8ulqdTr.irJrahl,.irrior5a{ud.l2nlfr a'n:r

vn Aly- u I d, I v-ot21l?fl Yt LFrTll fl 1:?UAfl fl ?1 rl lU t:n LdFt,l

u : o & , a,ontduaT{ Q1u'tu 103 Ftuuu 1"lu?13Jn1

Alvarado score sJlnn'ilfitorvir#u 7 nvLruu

(positive res u lt) tu n o u u: niu u a ul:.,iy,r tj1 u1 a

,iruru 86 nu uavfiaan'ir z nvuuusirurue\ A - | v y

17 nu zuU?uytf,i1Elfia{fl1:r.tlFtnttA? r{nfl1:q

fraurir.: 1 tffrur n urirlolr-iu nia u ulrfl EIlfivayu

a?B?1U fl n.l fl1:tn nR1'leLtm:flqtou Ft{ fla1?

u e,' f uv/, - dm ua1fl fl 1T:fl lfl rJu? U lTFt Ldohtfl n tdu tauu?\lau{ann{urina"ufi o-n:rnr:r.itd'or1#6.,:krahisirr{lu

aALy\l3J3.r1fl?tU

od.Lull n.FI.1986 Alvarado

drtaua Alvarado scoring system

4(a)a?tu

LFI

LIns

dn rau rdtlufl #ulfiria fl uuvrir'Lfrmr d1 rfi ndu'yaaueT?u Ft? U Uas:fl 1*1 Ft1ild1 tfi nUUfi :A:fl U1 Fl13J

reJ u u1 Lrasnl:u1hltfrlfio3{m1.,t nAfi n

?8.,lAlvarado score ?1A1Un1:finU1 L?iU n1:

6nurzo.,: Owen TD(4), Kalan M(5), LLas Fenyo

tm qjnu'jT nr:lfr AMarado score'tunr:ifi o#at fnui v - d - U a yL:n L6ln\:a n tdu Lauuylnuuuil n?13J n n no{

n?1 sJt? uagn?1 ilqi1 rylrsri al:n 4.,: In a rqt,t'tsq6l y r ia t a I uLUzuU?Um3JnvLtUUil1nfl?1?150t111flU 7q

a, *tv- , , i oe, 6tllur Lu nua ufi Lt?\:fi a1 fl rua.rm n M{1 Er :'r Ft r:?

unril:vm rior In eral FTEJ Fi1 nvruufilfior n

il:sr-fi nr:n:?ai1.r n1 fl LLasr{ n fl 1:Dr:rafl 1{vd,rn"'

ifiqfarilul:ndu1frte,l"ld1fi6..:d'nrdu qilu?u fronJfrffinr: IorErFrsuuu:?ru 9-i0 ns$uuo o Xa." ia6 nu Lualu?uu8JtJu?fl 4 num8JFtst[uu:?3Jrdtvd

8J1flfl?'tfiTotmlnu 7 nvttuu LLASAfl 2 AUd t vt, )q tv-tJFrsrLuu:?eJ 5-6 nettuu d?uill]?uytLLtLFTTUq

frla nrar{lul:nlf; fi .:dn rau rdsuyrauil1 nfi dFroo9o t u u v d

ttuslJl lfiYtln1:r.rlFtFtTfl1d,]muy] nvuuu:?eJ 7€nvuuufi lanrarfl ul:rrtdfi .,:o-nmurdaulrd'ururn

tao&a&,avvda:oXn1:r,l1FlFl a1u?u 26 nuuusJnvttuuT?ilrFht[LFt n1:t6ianmlrJlnnnumfi5an:rQtfliltn8JquaEi,.3-6 neLruu (n1fl.]fi 4)

9aAdyovnu nn u7\lJQ?t 8{ [L?\?1 U rJml n1::fl t*1 FtytLUU

r?sJ s-6 nvruu frlanrar{lul:n1#fi.,:a'nrau

rfl aun#utd uunirlfrrir n1:n:?a 1lfi e, rfiruldud

VYYotya1 fl?ail4fl1.:Ftuu13J1fi 1 m n'n3J6l fl na{q{

uasn1n1nm1u1g ?to{ Alvarado score lfirirn?1eil? Saaas m.s (86/1oe) rirnrrrus;rn{rs

5aflas 87.s (2}lge1 uardrn.t1iln1nfia,r1tli qe v ymavLFr,.lnu?n0nna{ Toflas 95.6 (86/90) Lms

ovton1u?6uomfl flmtfl Ft negative appendicectomy

lfi5oaac 5.5 (6i1oe)

^d?o1t6lt

cr abdomen ufiialfrlfinr:ifi odeffi n n fra.,:m n{A+d.uflu nvuuu:?rr 1-4 nyuuu fllanrar{|ulf;fi.r

o'r fl 1t'[upir.-:r]:vrm rrlfifi fifinr*r6.: nmrun nfra.,:qq

d.r rir riqr a r nT :i fi q d'al:n1#fi .: o-n rau4-- Y A aa u A e IrQuuilau na fl1:?uaflflm6tnna{ [ay[L8Ju e

(u) rir mfuluil:rrn ntm er r?sJ fi nr:6nu1 rd EJ?oai

U1 tvlonn morbidity tLas mortality alnn'l:ifi oa'ufi nilnrnvrtarirfr ruayEl-.,r?i?uann1:ri1

n-nfilile'1 rfl uat luafa dau rirh al:nt#fi r{u - d u dv )

O fl tflu tAfl Ult'lAUil O Ft:1 Fl1 El 6l\: tIA{01 n

fl-u Alvarado score rurn{u d.,:nr:dnr*rdru

AA s f \4 y , y o a 99?uaafl [TnLna1t1 yt1 [14rJil?E]rRnfl1?srrmrn

The Alvmdo Scori ng System tirn r:?fi tdul:nl #cildnr aurfi uufl a'u

81 The Alvmdo Scoring System for ur 6 auu7t 3 n.H.-E.n. 2552

tu{urialrl mtardafi a1n1rilxnfro{il1n{u

n1rfi nw1 nf.,,d t*,taa n n1 il,1d? ud fi nruuu

r?rl 1 -4 nrLruuuasarlrgrntfrna'urirulfi

Ifl:lJq

Alvarado scoring system msJ1ln?i?U

'[u n r :i fi o {aI: nt# fi .,: a-n r a u rfi s u il n'ul fi o?.,:

Irr EJ uqilrvtunri ar frrh EJdfi nr,ruu:?r,,il1 nn'i1qsAtvx

}1TAtm1flU 7 FtvUUU UanAlnU Alvaradouog{Yt d , v

score Eh:[tLFtil1u 6lcn?n :?Ft[i? tj:rfiEln Ltas

tei riluaun:r u ria rid'r u ar s,n:n1ff1fi6rfttu{e tt 6 eat ' < A oeridr a rd n uavrf,lr ni 6.: rm rursf, rufi oc'[{rilu{{o

d i a g nostic test tul:.,: yl u 1 u 1 a lemu d e,r' rrn yr dq

outnrjr{ludrulmqj

aaaRnflnt:ilil:eR1fl

?a?ou n 6u ur u tty{n Eiari n: a.,:rur.,: riq

frrirur a nr:I:.,:n ururaa1 q u1? id'lfr n.tq

n s L[u u (8)

u ril:t il EJ r u r a de u'[m ni f.,:trit fi rira oy a o --score fi rur'[ff03.,:"[unr.,: nfi fi n In fl rqy{ry'lu

I[:{1{Er1U1A{ilUU

q

a1 fl fl T :6n*, n#odrfl u nr:drAlvarado scoring system an'tff03.,:nr.,: n6fi n'[uI:.,: r,r a r ur a tru zuln a rd o ntff n.r :#.-: r n n

ar nr:{rJa u'[ul:.,:fl srur a rilu ra ar 24 ?idil{r o' a J r oe

'UnU n1:6\: FIT? 8 [?\ il tFl 3i [TtA A n n1 ltSir A Uas--o!q, I A A t dvTt1 LFh:1 U 1l{riAn1:Flfl UlUy'lU?1ilam:tnmlnn

negative appendcectomy Soaar s.s rdad u i Aa-

Lyt fl u fl UT1 ghlluaunila nfl fl 1:tfl a negative

appendectomy iaaar 14.4?t uac Saaac

17.s(6) eirmiurirnmruhiaaac Bg.5 rtas

rirnru,itnr#aaay 87.s dt6"Lunr:6nr*rdd 6t y d u

' jrry d

fr nar ru"ln drF a.,: nn rirfi 1fi or n nt:6 n r*r'[ui a,rtl{u:slll Fl ytyruru n1 n?truhfaaas go.2 uag

rirnmilsirrlm#aaay 91 .4(6) uaynr:6nur'lu

rhsrmn yrufi rir nmrulr LmsnmeJdl rilr#aelac

es uaviaunc B7(8) ttayalnFiln?1un1olfi ru.la-i^'l-g-.--.- e 6t a. e NYtesLFt rJau?fl fl nna{ [unt:Flnur a:.,:u

Saaav gs.o hlrda.:rYumnra 1 nr:dnr*rfilvv

:rfl.,rruli5aEJay 94.3(4), g7.s(5) uas 96.0(8)ou-&lamlJdlnil O.,tUll Alvarado score ilQl:atruf:A

rir rurtfr'"lul:{y{ cr1 u1 nre,{dfi 6 Ior u railr ;-q-,r^-.-ia

t , a t u

ryu2 Etyt3.t FrsLLuu:?tJil.1 n n?1il5a tyir nu 79 e Y n lansltuu 611mTuilu?fl7tfrjnsLtuu:?&t 5_6

. -,t - cry aa vnsLruu alaalruuFto{ lun1:ailaaufi a1fl I+dr v t I yi2fr:?&Jfl U tUU n1:6liltfl n01n1??lo.:l.tilffliailanunt:il:srfruo1nt:uasil:srfiu score6

rtlu:verv j uayfi ar:rurd.,:n:rorfi ru 16ru lffudultrasound nta cf scan ray{1Jluflufie'1r{luJ e r Aa &6t?uflu?u?tilnyuuu:?tJ'1-4 ncuuu uuq

d'r sJmntfr nfu rirulfi mcuucdr'lfru1 rrmodl

.u aq 619 Xduu 6luu{1u?a u tlaeou qt n-[ll taua:1 uitluii-- Y v v A yn:? ilYr{fl afl au n 6u[a1fi ulyt rrrJu n r,tile uua nqq

fra.,: n:rorYa u n:Til uasrffrmfird rrzuunfirJeuq j, d o o av[uYrt?fl rfi na Lunl:n1IaEt

(, I C

6l?::nu:vt1:nut?td1: o:nl l?{filrttJ 182

r.:d'rfiEl:6zo:, it'a ttduffi, oiavr.rri lnurJrJ{nn, u::rurBnr:. Surgical complication.^ t {,)firufirriofi 1. n!{ryrv{eJfi1un:: Isr0nnr:firuvfl; 25aG. uilt fia-zos.

2. Jaffe BM, A"rg", DH. The appendix. ln: Brunicard, editor. Schwartz's principle of

surgery. 8'h ed. USA : McGraw-Hill; 2005. p.1119-38.

3. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann

Emerg Med 1986; 15: 557-64.

4. Owen TD, William H, Stiff G, Jenkinson LR, Rees Bl. Evaluation of the Alvarado

score in acute appendicitis. J R Soc Med 't992; 85: 87-8.

5. Kalan M, Talbot D, cunilffe WJ, Rich AJ. Evaluation of the modified Alvarado

score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg

1994;76: 418-9.

6. Fenyo G, Lindberg G, Blind P, Enochsson L, Oberg A. Diagnostic decision support

in suspected acute appendicitis: validation of a simplified scoring system. Eur J

Surg 1997; 163: 831-8.

7. Ohmann C, Yang Q, Franke C. the abdominal pain study group : diagnostic score

for acute appendicitis. Eur J surg 1995; 161: 273-81.

B. i3fls ufirrY{dn1a, iltlv rdaril:rro?g. nr:il:vffiu Avarado score'[u{rJruida.,:ferv yo' v d e A aa u i- ,r yj a a u

R1?EL6{0t{0nLdUtAUUv\lAU ty{On1:'tUAAUL:nLdn.*tont6lutqUU}lAU. ?1:d1:dil1nilu rd,n ,

flAUuilTlElYlxLlJ 2547; 1: 8-16.

tonmrdr{a{1. t'trufru fifin:mfit. Complication of appendectomy. tu, q?il.1d qnlnrni, qfiFt

The Al vilado Scori ng System fi'ln r:ifi odul:nI #n' l6'nr aurfi ulu6'uThe Alvaado Scoring System for ufl 6 auuYt 3 n.Ei.-n.F. 2552

Alvarado scoring Form

Score Yes/No

symp :

Sign :

Lab :

Migratory of pain

Anorexia

Nausea/vomiting

RLQ pain

Rebound tenderness

Elevation temp (>37.5 c)

leukocytosis (>1 0,000)

Left shift (>75"/")

1

1

1

2

1

1

2

1

Total score

gr-Jfi r Alvarado scoring Form

j " v,, t, o

Fl1:'t{Yt 1 a1u?u alil? EJ1ht14 tJ n a1 tLu fl Fl,t 3J 01 fl tlayty{ Flqa

drrarq Gt)tflFI qilu?u(ffaans)

?t1U fifU',1

oo tldulu

o-14

1 5-29

30-44

45-59

8(5.e)

24(17.8)

8(5.e)

13(e.7)

3(2.2)

4(2.e)

30(22.2)

21 (15.6)

17(12.6)

7(5.2)

56(41.5) 7e(58.8)

€, v I6l?::Fl1l:sf,1:fl 1*L?t6{1: 6:nr lxdrnu 184

rtt:1.,rfi z .irurufrrlrfl'luuriacnsLruu:?ru ?to.,i Alrarado score

nsuuu:?iJ siruru(5auac)

1

2

3

4

5

6

7

8

I10

0

0

8(6.0)

11(8.0)

18(13.3)

8(6.0)

2O(14.8)

32(23.7)

28(20.8)

1o(7.4)

1 35(1 00)

rlt:1.,lfi 3 ruanr:rir rio LtasrJnn:'teyt1.-ly,l fl lBeng't

druru{rha(iaaar)

lnflammed appendix

Acute appendicitis

Gangrenous appendix

Ruptured appendix

Non-appendicitis

Ruptured ovarian cyst

caecal direrticulitis

lntussusception of ileum

No pathologic found

84(77.1)

e(8.3)

10(e.2)

2(1.8)

1(0.e)

1(0.e)

2(1.8)

1 35(1 00)

The Alvamdo Scuing system rilnr:?fi tf,uI:ol#6rdnrarurfiuuv{a'u

fld o qfud 3 n.s.-fi.a. 2s52

Am?1.,:fi 4 rJnn1:0r:'tedrEl Alvarado score ttnszuan1:efiodg

Alvarado score

AAVn11?UAAir

Appendicitis Non-appendicitis:1lt

Positive result 7

Negative result <7

86

17

90

45

4

28

??'J 103 135