alvarado score, ultrasound, and crp: how to combine them for the most accurate acute appendicitis diagnosis

Background: the aim of the current study was to investigate whether the usage of three diagnostic methods of acute appendicitis which are alvarado score, c- reactive protein (crp) levels and ultrasound (us) in combination improves diagnostic accuracy significantly. patients and methods: data were analyzed in 254 patients with suspected appendicitis who had a sonographic examination and a crp value. the patients were classified into four groups according to both alvarado score and us findings. us results, alvarado score, and crp levels were compared. results: the most specific test among three diagnostic methods was sonography. combination of an alvarado score higher or equal to 5, a high crp level (≥ 0.8) and a sonographic examination as appendicitis with visualization of an inflamed or perforated appendix was more specific than us alone. an alvarado score higher or equal to 5 (86.2%) was found to be the most sensitive criteria. conclusions: using alvarado score, us and crp levels in combination provides us to confirm or rule out acute appendicitis safely.