Use of a modified Alvorado score in the diagnosis of XXXX .

@entity1 @entity697 @entity698
BACKGROUND: The negative appendicectomy rates have remained high. The integration of clinical scores into the diagnostic process in @entity697 has had the purposes of improving decision making and reducing the negative rates in this common condition. The performance of these score systems have however, not been uniform. OBJECTIVE: To assess the usefulness of a modified Alvorado score (1986) to predict groups of @entity1 with suspected @entity698 for definite surgery, observation or discharge from hospital. DESIGN: Prospective study. SETTING: Kenyatta National Hospital (KNH), a central referral and teaching hospital in Nairobi, Kenya. @entity1 : One hundred and eighty nine @entity1 with suspected @entity697 were studied over a period of twelve months. METHODS: Five symptoms and four signs were assigned numerical values and the @entity1 scored out of a total of 10 points. A score of >7 predicted mandatory operation, 5-6 observation and score 1-4 predicted those not considered for surgery. The decision to operate was the prerogative of the surgeon or surgical resident based on overall clinical suspicion and not the diagnostic score. RESULTS: The proportion of @entity1 with scores >7 was 40.7%. The mean score was 6.02. The mean ages and the gender ratios were similar across score groups. The negative appendicectomy rate was 17.6% for group 1-4, 16.5% for 5-6 and 19.7% for >7. These were similar to the overall negative rate of 18% based on clinical suspicion. The overall sensitivity and sensitivity for the scoring system was 80.3% and 16.8% respectively. CONCLUSION: High scores were found to perform poorly in predicting diagnosis of @entity697 preoperatively and in the reduction of negative appendicectomies. The integration of a scoring system does not offer advantage over degree of clinical suspicion.
