How effective is the MANTRELS score in diagnosing appendicitis?

Updated: Jul 23, 2018
  • Author: Sandy Craig, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Clinical scoring systems are attractive because of their simplicity; however, none has been shown prospectively to improve on the clinician's judgment in the subset of patients evaluated in the emergency department (ED) for abdominal pain suggestive of appendicitis. The MANTRELS score, in fact, was based on a population of patients hospitalized for suspected appendicitis, which differs markedly from the population seen in the ED.

In reviewing the records of 150 ED patients who underwent abdominopelvic computed tomography (CT) scanning to rule out appendicitis, McKay and Shepherd suggested that patients with an MANTRELS score of 0-3 could be discharged without imaging, that those with scores of 7 or above receive surgical consultation, and those with scores of 4-6 undergo CT evaluation. [19] The investigators found that patients with a MANTRELS score of 3 or lower had a 3.6% incidence of appendicitis, patients with scores of 4-6 had a 32% incidence of appendicitis, and patients with scores of 7-10 had a 78% incidence of appendicitis. [19]

In another study, Schneider et al concluded that the MANTRELS score was not sufficiently accurate to be used as the sole method for determining the need for appendectomy in the pediatric population. [20] These investigators, studied 588 patients aged 3-21 years and found that a MANTRELS score of 7 or greater had a positive predictive value of 65% and a negative predictive value of 85%.


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