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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2010 August;23(4):99-101
Combination of mantrels score and abdominal ultrasound for the diagnosis of acute appendicitis in the emergency department. A randomized prospective study
Caiazzo P. 1, Pennacchio E. 1, Lisanti F. 1, Scarano E. 2, Cavallo T. 2, Gaudino G. 1, D’adamo M.G. 1, Di Lascio P. 1, Limauro S. 1, Autilio M. 1
1 U.O. di Pronto Soccorso e Medicina d’Urgenza, Potenza, Italy
2 U.O. di Radiologia, Potenza, Italy
Aim. The aim of this study is to determine the diagnostic performance of combining the abdominal ultrasound (US) and the Alvarado score in a population of patients who presented to the Emergency Department (ED) for suspected acute appendicitis. Clinical scores, such as the MANTRELS score created by Alvarado, may improve the diagnostic yield.
Methods. 202 consecutive patients who presented to the ED for suspected acute appendicitis (M/F=110/92), aged 4 to 76 (average age=18.1 years). The patients were randomly assigned to two groups. Patients in Group A (no.=87) were evaluated with the Alvarado score, CBC (Complete Blood Cell Count) tests and abdominal US; patients in Group B (no.=115) were evaluated using the Alvarado score and CBC tests.
Results. For patients in Group A, diagnostic sensitivity of acute appendicitis was 100%, specificity of 97%, PPV (Positive Predictive Value) of 97% and NPV (Negative Predictive Value) of 100%. For patients in Group B, diagnostic sensitivity of acute appendicitis was 58%, specificity of 69%, PPV of 69% and NPV of 58%.
Conclusion. Mortality and morbidity rates from acute appendicitis increase significantly with the delay in diagnosis and therapy. Many diagnostic clinical scores were created with the aim to reach 100% of diagnostic sensitivity, thereby reducing therapeutic delay and minimizing negative appendectomy rates; the most used of these scores is the MANTRELS score, created by Alvarado in 1986. In our study, the combination of abdominal US and MANTRELS score has allowed us to attain higher percentages than the clinical evaluation alone. Acute appendicitis is a diagnostic challenge for physicians in the ED. Abdominal US improves the diagnostic yield of the clinical approach, reducing delay in therapy and avoidable surgical operation. These results are mainly due to modern US equipment and to the ample diffusion of US training schools.