Prospective comparison of the Alvarado score and CT scan in the evaluation of suspected XXXX : a proposed algorithm to guide CT use.

@entity1 @entity698
BACKGROUND: Although computed tomography (CT) has reduced negative appendectomy rates, its radiation risk remains a concern. We compared the performance statistics of the Alvarado Score (AS) with those of CT scan in the evaluation of suspected @entity698 , with the aim of identifying a subset of @entity1 who will benefit from CT evaluation. STUDY DESIGN: We performed prospective data collection on 350 consecutive @entity1 with suspected @entity698 who were evaluated with CT scans. The AS for each @entity1 was scored at admission and correlated with eventual histology and CT findings. The sensitivity, specificity, and positive likelihood ratios were determined for various AS and for CT scan. The AS ranges that benefitted most from CT evaluation were determined by comparing the positive likelihood ratios of CT scan with each of the AS cutoff values. RESULTS: The study included 134 males (38.3%) and 216 females (61.7%). The overall prevalence of @entity698 was 44.3% in the total study population; 37.5% in females and 55.2% in males. There were 168 @entity1 (48%) who underwent surgery, with a negative appendectomy rate of 7.7%. Positive likelihood ratio of disease was significantly greater than 1 only in @entity1 with an AS of 4 and above. An AS of 7 and above in males and 9 and above in females has a positive likelihood ratio comparable to that of CT scan. CONCLUSIONS: Evaluation by CT is beneficial mainly in @entity1 with AS of 6 and below in males and 8 and below in females. We propose an objective management algorithm with the AS guiding subsequent evaluation.
