title: Can the efficiency of modified Alvarado scoring system in the diagnosis acute appendicitis be increased with tenesmus?
abstract: BACKGROUND
  Acute appendicitis is one of the main pathological conditions requiring emergency surgical intervention. The most widely accepted scoring system is modified Alvarado scoring system (MASS). In this study we aimed to improve the efficiency of MASS by adding a new parameter and to evaluate its efficiency in the diagnosis of acute appendicitis.
  
  
  METHODS
  This study included 158 patients who underwent acute appendectomy in Keçiören Training and Research Hospital General Surgery Department. In addition to criteria of MASS, all patients were questioned about the presence of tenesmus. The validity of MASS and MASS with additional parameter was evaluated with respect to sensitivity, specificity and positive and negative predictive values.
  
  
  RESULTS
  Accuracy rates of MASS, clinical findings, ultrasonography and MASS with additional parameter in the diagnosis of acute appendicitis were 64, 76, 85 and 80 %. False positivity rates for clinical findings, MASS and MASS with additional parameter in the diagnosis of acute appendicitis were 17, 26 and 10 %, respectively. Sensitivity and specificity of clinical findings in the diagnosis of acute appendicitis were 83 and 66 %, respectively. Sensitivity and specificity of MASS in the diagnosis of acute appendicitis were 74 and 39 %, respectively, and those of MASS with additional parameter were appendicitis increased to 83 and 66 %, respectively.
  
  
  CONCLUSIONS
  MASS is a simple, cheap and objective scoring system and does not require expertise. When tenesmus is added to standard MASS, rates of accuracy, sensitivity and specificity become better than those in MASS in the diagnosis of acute appendicitis.
authors.affiliation: Kecioren Training and Research Hospital, General Surgery Clinic, Kecioren, Ankara, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Bulus
authors.forename: Adnan
authors.initials: A
authors.lastname: Tas
authors.forename: Baris
authors.initials: B
authors.lastname: Morkavuk
authors.forename: Seyfettin
authors.initials: S
authors.lastname: Koklu
authors.forename: Derya
authors.initials: D
authors.lastname: Soy
authors.forename: Ali
authors.initials: A
authors.lastname: Coskun
mesh_terms: D000006:Abdomen, Acute / Q000175:diagnosis* / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000150:complications* / Q000175:diagnosis*; D005242:Fecal Incontinence / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult