How accurate is the Alvarado scoring system in the diagnosis of acute appendicitis in adults and children?

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The Alvarado score is accurate for ruling out acute appendicitis in adults and children when the score is less than 5. A low Alvarado score (<5) has more utility for ruling out appendicitis than a high score (≥7) has for ruling in the diagnosis (SOR: A, meta-analyses of consistent cohort/case-control studies). An Alvarado score of less than 5 with a pretest probability up to 40% in children and up to 60% in adults effectively rules out appendicitis with a posttest probability of less than 3% (SOR: A, metaanalysis of consistent cohort studies).

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