Author(s): Meltzer AC, Baumann BM, Chen EH, Shofer FS, Mills AM
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Abstract STUDY OBJECTIVE: A clinical decision rule that identifies patients at low risk for appendicitis may reduce the reliance on computed tomography (CT) for diagnosis. We seek to prospectively evaluate the accuracy of a low modified Alvarado score in emergency department (ED) patients with suspected appendicitis and compare the score to clinical judgment. We hypothesize that a low modified Alvarado score will have a sufficiently high sensitivity to rule out acute appendicitis. METHODS: We performed a prospective observational study of adult patients with suspected appendicitis at 2 academic urban EDs. A low modified Alvarado score was defined as less than 4. The sensitivity and specificity were calculated with 95\% confidence interval (CI) for a low modified Alvarado score, and a final diagnosis of appendicitis was confirmed by CT, laparotomy, or 7-day follow-up. RESULTS: Two hundred sixty-one patients were included for analysis (mean age 35 years [range 18 to 89 years], 68\% female patients, 52\% white). Fifty-three patients (20\%) had acute appendicitis. The modified Alvarado score test characteristics demonstrated a sensitivity and specificity of 72\% (95\% CI 58\% to 84\%) and 54\% (95\% CI 47\% to 61\%), respectively. Unstructured clinical judgment that appendicitis was either the most likely or second most likely diagnosis demonstrated a sensitivity and specificity of 93\% (95\% CI 82\% to 98\%) and 33\% (95\% CI 27\% to 40\%), respectively. CONCLUSION: With a sensitivity of 72\%, a low modified Alvarado score is less sensitive than clinical judgment in excluding acute appendicitis. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
This article was published in Ann Emerg Med
and referenced in Emergency Medicine: Open Access