Scoring and diagnostic laparoscopy for suspected XXXX .

@entity1 @entity697 @entity698
OBJECTIVE: To develop a reproducible scoring system to identify @entity1 who present with a doubtful diagnosis of @entity698 and who would benefit from diagnostic laparoscopy. DESIGN: Prospective observational study. SETTING: Regional teaching hospital, The Netherlands. SUBJECTS: 577 consecutive @entity1 during the period 1994-5, and 343 who presented during the period 1996-7. INTERVENTIONS: The variables that seemed to be predictive of @entity697 were abstracted from the earlier group. a logistic regression analysis applied, and score created. The score was validated on the 343 @entity1 who presented during 1996-7, and then the groups were combined for further analysis. MAIN OUTCOME MEASURES: Reproducibility of the scoring system obtained by comparing odds ratios (OR) of the two groups; its effectiveness judged by comparing the delayed and normal appendicectomy rates. RESULTS: The following variables were significantly correlated with the presence of @entity697 : white cell count 10 x 10(9)/L or more (score 3), rebound tenderness and male sex (score 2 each); and symptoms present for < 48 hrs and temperature 38 degrees C or more (score 1 each). The OR for the two groups were 1.80 and 1.76, respectively, indicating that score was reproducible. With a sensitivity of 93% and a specificity of 83% it would be at least as accurate as clinical judgment. The normal appendicectomy rate would be 7% instead of 9%. and the negative exploration rates (laparoscopy and primary appendicectomy) would both be 22%. The score would also result in a lower perforation rate (2% compared with 17%). CONCLUSION: The score can indicate when there is an indication for laparoscopy in @entity1 with suspected @entity698 .
