Improved Alvarado Score (MANTRELS) for the Early Diagnosis of Acute Appendicitis

Abstract

relevant features were: Elevated WBC, RLQ tenderness, combination of anorexia, nausea or vomiting, rebound tenderness, migration of pain to the RLQ, and elevation of temperature. In another study, Sandell, et al. [2] found that, among the signs, tenderness in the right iliac fossa had the greatest impact on the decision to perform appendectomy with an odds ratio (OR) of 80.3 followed by indirect tenderness with an OR of 29.1. Among the symptoms, they found that pain migration was the most important symptom with an OR of 23.6, and image diagnostics gave an OR of 4.99. All of these signs and symptoms had a p-value of < 0.001. Wilasrusmee, et al. [3] in a systematic review of scores performance, found that rebound pain was the most common sign (76.9%) followed by right lower quadrant tenderness (61.5%), and right lower quadrant guarding or elevated temperature (53.9% for both). Ten symptoms were considered in which nausea (64.3%) followed by migration and duration of pain (46.2%) were most commonly included. They also found that leukocytosis and shift to the left were present in 76.9% and 46.2%, respectively. They noted that eight predictors of the Alvarado score had a calibration coefficient of 1.0 which is very good. They constructed a table including 14 derivation studies where it is important to point out that the original Alvarado score Abstract After a careful analysis of various diagnostic scores on acute appendicitis I am introducing here an Improved Alvarado score (MANTRELS) that includes several substitute predictive factors aimed to obtain better clinical results.