The Value of the Alvarado Score for the Diagnosis of Acute Appendicitis in Children: A Systematic Review and Meta-Analysis

Background: Relevant guidelines recommend the use of the Alvarado score (AS) to assist in the diagnosis of acute appendicitis (AA) in children. To provide reference evidence for the clinical application of AS, we performed a meta-analysis of studies related to the diagnostic accuracy of AS in children with AA.Methods: We searched the relevant literature from databases including CNKI, WanFangdata, VIP, CBM, the Cochrane Library, PubMed, Embase, and Web of Science databases from the date of database creation to April 30, 2022, and screened them according to nadir criteria, followed by data extraction and then combined effect sizes to assess the accuracy of AS for diagnosis in children.Results: Twenty-six studies involving 2579 cases were finally included, including 19 studies with Alvarado score and 8 studies with modified Alvarado Score (1 study included both Alvarado Score and modified Alvarado Score). The combined sensitivity (SE) of AS for diagnosing AA in children was 76.0% (95% CI 74.0-78.0%; I2 = 95.1%); combined specificity (SP) was 71.0% (95% CI 68.0-74.0%; I2 = 86.4%); combined positive likelihood ratio (LR+) was 2.43 (95% CI 1.92-3.07; I2 = 78.7%); combined negative likelihood ratio (LR-) was 0.28 (95% CI 0.20-0.41; I2 = 94.2%); combined AUC = 0.8092, Q* = 0.7439; combined diagnostic ratio (DOR) was 8.96 (95% CI 5.65-14.21; I2 = 76.2%). The combined effect size I2 was greater than 50% for all children with a modified AS diagnosis of AA, so all analyses used a random-effects model, which showed a combined SE of 87.0% (95% CI 85.0 -88.0%; I2 = 85.5%); the combined SP was 47.0% (95% CI 43.0 -51.0%. I2 = 88.7%); combined LR+ was 1.68 (95% CI 1.31-2.17; I2 = 85.9%); combined LR-was 0.28 (95% CI 0.20-0.39; I2 = 74.3%); combined AUC = 0.8672 and Q* = 0.7978. The combined DOR was 6.43 (95% CI 3.38-12.26; I2 = 80.0%). Conclusion: The results of this meta-analysis suggest that the accuracy of AS in diagnosing AA in children is moderate, and AS can be an auxiliary tool for the diagnosis of AA in children, relying on AS alone for the diagnosis of AA is not recommended; AS can be further improved scientifically to increase its diagnostic value. (c) 2023 Elsevier Inc. All rights reserved.