Prospective study of computed tomography in patients with suspected acute appendicitis and low Alvarado score

Am J Emerg Med. 2012 Oct;30(8):1597-601. doi: 10.1016/j.ajem.2011.10.021. Epub 2011 Dec 26.


Background: Computed tomography (CT) has been used in diagnosing acute appendicitis since late 1990s. Appropriate use of CT has not been studied prospectively in patients with suspected acute appendicitis and relative low Alvarado score.

Methods: Sixty participants with suspected acute appendicitis and an Alvarado score of 4 to 7 points were enrolled for analysis. Clinical and laboratory differences were compared between patients with histologically proven acute appendicitis (AA group) and patients without evidence of acute appendicitis (non-AA group) in the first part of the analysis. In the second part of the analysis, participants were divided into 2 groups: leukocytosis (LK group) and nonleukocytosis (non-LK group).

Results: In the first phase of the analysis, there were statistically significant differences in white blood cell count (13.5 K vs 10.9 K per μL), neutrophilia (81.5% vs 73.5%), and hospital stay (4.9 vs 3.5 days) between the 2 groups. Disease spectrum between LK and non-LK groups was obtained in second part of analysis.

Conclusion: Computed tomography scan is necessary for patients with relatively low Alvarado score when leukocytosis is noted. In female patients without leukocytosis, further large-scale prospective studies are necessary to change the current diagnostic strategy.

MeSH terms

  • Acute Disease
  • Adult
  • Appendicitis / complications
  • Appendicitis / diagnosis
  • Appendicitis / diagnostic imaging*
  • Decision Support Techniques
  • Diagnosis, Differential
  • Female
  • Humans
  • Leukocytosis / etiology
  • Male
  • Prospective Studies
  • Tomography, X-Ray Computed*