Predictive value of C-reactive protein, ultrasound and Alvarado score in acute appendicitis: a prospective pediatric cohort

Purpose: To evaluate whether C-reactive protein (CRP) level and ultrasound (US) results on admission could aid the diagnostic accuracy of Alvarado score. Methods: A prospective study was performed on children <14 years admitted for suspected acute appendicitis. Patients were categorized into three groups based on the Alvarado score: group I: score 7-10, group II: score 5-6, group III: score 0-4. Results: The difference between predictive values of Alvarado score alone and Alvarado score with CRP was not statically significant. The PPV increased from 74.29% (Alvarado score and CRP) to 93.75% (Alvarado score and US) in group 1 (P =. 001) and the NPV increased from 64.86 and 79.69% (Alvarado score and CRP) to 82.6 and 88.2% (Alvarado score and US) in group 2 (P = .01) and group 3 (P = .001), respectively. Conclusions: Alvarado score and ultrasound taken together improve the predictive value of diagnosing acute appendicitis in children. (C) 2015 Elsevier Inc. All rights reserved.