title: Low sensitivity of the exit site scoring system in detecting exit site infections in peritoneal dialysis patients.
abstract: BACKGROUND
  To evaluate the utility of the exit site scoring system in diagnosing exit site infections, we compared its scores to the well established exit site categories outlined by Twardowski and Prowant.
  
  
  METHODS
  We examined the exit sites of 50 patients on peritoneal dialysis. Each exit site was given a score ranging from "zero" to "≥ 4" according to the exit site scoring system. Exit sites were simultaneously classified into one of the exit site diagnostic categories outlined by Twardowski and Prowant. The sensitivity and specifity of the exit site scoring system in diagnosing exit site infection was then calculated in reference to the exit sites classified as infected according to Twardowski criteria.
  
  
  RESULTS
  The proportions of perfect, good, equivocal, and infected exit sites were 24%, 22%, 32%, and 22%, respectively. 21 exit sites had an exit site score of zero. Of those, 12 (57.1%) were perfect, 7 (33.3%) were good, 1 (4.8%) was equivocal, and 1 (4.8%) was actually infected. 21 exit sites had an exit site score ranging from 1 to 3 without purulent discharge. Of those, 4 (18.2%) were good, 15 (68.2%) were equivocal, and 3 (13.6%) were infected. The specifity of the exit site scoring system in diagnosing exit site infection was 100%, but its sensitivity was only 63.6%.
  
  
  CONCLUSIONS
  The exit site scoring system is not a sensitive tool for diagnosing exit site infection mainly because it ignores evaluation of the sinus for granulation tissue. Exuberant granulation tissue in the sinus tract is not always accompanied by purulent drainage.
authors: Sarra
authors: S
authors: Elamin
authors: Maysoon Em
authors: ME
authors: Khaier
authors: Babikir G
authors: BG
authors: Kaballo
authors: Hasan
authors: H
authors: Abu-Aisha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006097:Granulation Tissue / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D011237:Predictive Value of Tests; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D014945:Wound Healing; D014946:Wound Infection / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D055815:Young Adult