The Alvarado score for predicting acute appendicitis: a systematic review.
The Alvarado score for predicting acute appendicitis: a systematic review.
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DOI：
10.1186/1741-7015-9-139
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发表时间：
2011-12-28
期刊：
影响因子：
9.3
通讯作者：
Dimitrov BD
中科院分区：
文献类型：
--
作者：
Ohle R;O'Reilly F;O'Brien KK;Fahey T;Dimitrov BD
Alvarado评分可用于对疑似阑尾炎的患者进行分层；该评分在某些患者组和不同切割点的有效性尚不清楚。本研究的目的是评估阿尔瓦拉多评分的鉴别（诊断准确性）和校准性能。系统检索Medline、Embase、DARE和Cochrane图书馆的验证研究，直至2011年4月。我们在两个分界点评估评分的诊断准确性：分界点为5分（1至4分vs. 5至10分）和分界点为7分（1至6分vs. 7至10分）。对低（1至4）、中（5至6）和高（7至10）风险层进行校准分析。分析集中在三个子群体：男性、女性和儿童。该综述纳入了42项研究。在诊断准确性方面，5分的分界点很好地“排除”了阑尾炎的入院（总体敏感性99%，男性96%，女性99%，儿童99%）。在“确诊”阑尾炎并进展到手术的分界点7分时，每个亚组的评分都很差（总体特异性81%，男性57%，女性73%，儿童76%）。阿尔瓦拉多评分在所有风险阶层的男性中都得到了很好的校准（低RR 1.06, 95% CI 0.87至1.28；中RR 1.09, 0.86至1.37；高RR 1.02, 0.97至1.08）。这个分数过高地预测了中、高风险群体的儿童以及所有风险阶层的妇女患阑尾炎的概率。Alvarado评分是一种有用的诊断“排除”评分，对所有患者组的切点为5。该评分在男性中校准得很好，在儿童中不一致，并且在所有风险阶层中高估了女性患阑尾炎的可能性。
The Alvarado score can be used to stratify patients with symptoms of suspected appendicitis; the validity of the score in certain patient groups and at different cut points is still unclear. The aim of this study was to assess the discrimination (diagnostic accuracy) and calibration performance of the Alvarado score. A systematic search of validation studies in Medline, Embase, DARE and The Cochrane library was performed up to April 2011. We assessed the diagnostic accuracy of the score at the two cut-off points: score of 5 (1 to 4 vs. 5 to 10) and score of 7 (1 to 6 vs. 7 to 10). Calibration was analysed across low (1 to 4), intermediate (5 to 6) and high (7 to 10) risk strata. The analysis focused on three sub-groups: men, women and children. Forty-two studies were included in the review. In terms of diagnostic accuracy, the cut-point of 5 was good at 'ruling out' admission for appendicitis (sensitivity 99% overall, 96% men, 99% woman, 99% children). At the cut-point of 7, recommended for 'ruling in' appendicitis and progression to surgery, the score performed poorly in each subgroup (specificity overall 81%, men 57%, woman 73%, children 76%). The Alvarado score is well calibrated in men across all risk strata (low RR 1.06, 95% CI 0.87 to 1.28; intermediate 1.09, 0.86 to 1.37 and high 1.02, 0.97 to 1.08). The score over-predicts the probability of appendicitis in children in the intermediate and high risk groups and in women across all risk strata. The Alvarado score is a useful diagnostic 'rule out' score at a cut point of 5 for all patient groups. The score is well calibrated in men, inconsistent in children and over-predicts the probability of appendicitis in women across all strata of risk.
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DOI：
10.1590/s1519-38292003000400008
发表时间：
2003-12-01
期刊：
Revista Brasileira de Saúde Materno Infantil
影响因子：
--
作者：
Borges, Paulo Sérgio Gomes Nogueira;Lima, Marilia de Carvalho;Falbo Neto, Gilliatt Hanois
通讯作者：
Falbo Neto, Gilliatt Hanois
影响因子：
4.4
作者：
Denizbasi, Arzu;Unluer, Erol Erden
通讯作者：
Unluer, Erol Erden
影响因子：
2.3
作者：
Karakas, SP;Guelfguat, M;Singh, SP
通讯作者：
Singh, SP
影响因子：
105.7
作者：
Bachmann, LM;Kolb, E;ter Riet, G
通讯作者：
ter Riet, G
影响因子：
1.4
作者：
Escriba, Alexandre;Maria Gamell, Anna;Luaces Cubells, Carlos
通讯作者：
Luaces Cubells, Carlos