<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2444-054X</journal-id>
<journal-title><![CDATA[Cirugía y cirujanos]]></journal-title>
<abbrev-journal-title><![CDATA[Cir. cir.]]></abbrev-journal-title>
<issn>2444-054X</issn>
<publisher>
<publisher-name><![CDATA[Academia Mexicana de Cirugía A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2444-054X2019000600674</article-id>
<article-id pub-id-type="doi">10.24875/ciru.19000866</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Modificación de la escala de Alvarado con semiología del dolor para el diagnóstico de apendicitis aguda]]></article-title>
<article-title xml:lang="en"><![CDATA[Modification of Alvarado score with pain semiology for the diagnosis of acute appendicitis]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Dzib-Calan]]></surname>
<given-names><![CDATA[Ernesto A.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Hernández-Rojas]]></surname>
<given-names><![CDATA[Manuel A.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Murata]]></surname>
<given-names><![CDATA[Chiharu]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Morales-Pérez]]></surname>
<given-names><![CDATA[Jorge I.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Larracilla-Salazar]]></surname>
<given-names><![CDATA[Ivanhoe]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mérida]]></surname>
<given-names><![CDATA[Gustavo Leal]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital General Naval de Alta Especialidad Servicio de Cirugía ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Instituto Nacional de Pediatría Departamento de Investigación ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital General Naval de Alta Especialidad Áreas Quirúrgicas ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2019</year>
</pub-date>
<volume>87</volume>
<numero>6</numero>
<fpage>674</fpage>
<lpage>681</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2444-054X2019000600674&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2444-054X2019000600674&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2444-054X2019000600674&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Antecedentes: La apendicitis aguda es la patología quirúrgica más frecuente en los servicios de urgencias. Afecta aproximadamente al 9% de la población. Su diagnóstico diferencial es en extremo difícil, en especial en ancianos, niños y mujeres en edad fértil. La escala de Alvarado (EA) es una herramienta útil para la sospecha diagnóstica de apendicitis. Nuestra experiencia sugiere la posibilidad de mejorar el desempeño diagnóstico de esta escala al incluir la semiología del dolor.  Objetivo: Comparar la utilidad diagnóstica de la EA con y sin incluir semiología del dolor utilizada en el Servicio de Cirugía General del Hospital General Naval de Alta Especialidad, así como identificar el menor número de variables útiles para el diagnóstico.  Método: Fueron revisados los expedientes de todos los pacientes operados por sospecha de apendicitis aguda de marzo de 2015 a marzo de 2017. Los pacientes incluidos cuentan con expediente completo y reporte histopatológico. Para cada paciente se establecieron el diagnóstico de apendicitis con la aplicación de la EA y agregando la semiología del dolor, y se contrastó el resultado con el diagnóstico histopatológico. Se estimaron los parámetros de utilidad diagnóstica de acuerdo con los puntos de corte determinados por el modelo de regresión logística y las curvas ROC.  Resultados: La EA modificada con semiología del dolor mostró una mayor utilidad diagnóstica que la escala original. Se identificaron, además, seis variables con un rendimiento satisfactorio.  Conclusión: La semiología del dolor puede mejorar la utilidad diagnóstica de la actual EA.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Background: Acute appendicitis is the most frequent surgical pathology in the emergency services. It affects approximately 9% of the population. Its differential diagnosis is extremely difficult especially in the elderly, children and women of childbearing age. The Alvarado score (AS) is a useful tool for suspected diagnosis of appendicitis. Our experience suggests the possibility of improving the diagnostic performance of this scale by including pain semiology.  Objective: To compare the diagnostic utility of AS with and without including pain semiology used in the general surgery service of the high specialty naval hospital, as well as to identify fewer useful variables for the diagnosis.  Method: The files of all the patients operated for the suspicion of acute appendicitis from March 2015 to March of the year 2017 were reviewed. The included patients have complete file and histopathological report. For each patient, diagnosis of appendicitis was established with the application of the AS and another, adding the pain semiology, and the result was contrasted with the histopathological diagnosis. The parameters of diagnostic utility were estimated, based on the cut points determined by the logistic regression model and the ROC curves.  Results: AS modified with pain semiology showed greater diagnostic utility than the original scale. Six variables were also identified with a satisfactory performance.  Conclusion: Pain semiology can improve the diagnostic utility of the current AS.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Apendicetomía]]></kwd>
<kwd lng="es"><![CDATA[Apendicitis aguda]]></kwd>
<kwd lng="es"><![CDATA[Diagnóstico]]></kwd>
<kwd lng="es"><![CDATA[Escala de Alvarado]]></kwd>
<kwd lng="en"><![CDATA[Appendectomy]]></kwd>
<kwd lng="en"><![CDATA[Acute appendicitis]]></kwd>
<kwd lng="en"><![CDATA[Diagnosis]]></kwd>
<kwd lng="en"><![CDATA[Alvarado score]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Anderson]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Bickler]]></surname>
<given-names><![CDATA[SW]]></given-names>
</name>
<name>
<surname><![CDATA[Chang]]></surname>
<given-names><![CDATA[DC]]></given-names>
</name>
<name>
<surname><![CDATA[Talamini]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Examining a common disease with unknown etiology:trends in epidemiology and surgical management of appendicitis in California 1995-2009]]></article-title>
<source><![CDATA[World J Surg]]></source>
<year>2012</year>
<volume>36</volume>
<page-range>2787-94</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Antal]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[[Changes in epidemiology, etiology, diagnostics, and therapy of acute appendicitis]]]></article-title>
<source><![CDATA[Orv Hetil]]></source>
<year>2009</year>
<volume>150</volume>
<page-range>443-6</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Raja]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
<name>
<surname><![CDATA[Wright]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Sodickson]]></surname>
<given-names><![CDATA[AD]]></given-names>
</name>
<name>
<surname><![CDATA[Zane]]></surname>
<given-names><![CDATA[RD]]></given-names>
</name>
<name>
<surname><![CDATA[Schiff]]></surname>
<given-names><![CDATA[GD]]></given-names>
</name>
<name>
<surname><![CDATA[Hanson]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Negative appendectomy rate in the era of CT (an 18-year perspective)]]></article-title>
<source><![CDATA[Radiology]]></source>
<year>2010</year>
<volume>256</volume>
<page-range>460-5</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Arroyo-Rangel]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Limón]]></surname>
<given-names><![CDATA[IO]]></given-names>
</name>
<name>
<surname><![CDATA[Vera]]></surname>
<given-names><![CDATA[AG]]></given-names>
</name>
<name>
<surname><![CDATA[Guardiola]]></surname>
<given-names><![CDATA[PM]]></given-names>
</name>
<name>
<surname><![CDATA[Sánchez-Valdivieso]]></surname>
<given-names><![CDATA[EA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Sensibilidad, especificidad y fiabilidad de la escala RIPASA en el diagnóstico de apendicitis aguda en relación con la escala de Alvarado]]></article-title>
<source><![CDATA[Cir Esp]]></source>
<year>2018</year>
</nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gilmore]]></surname>
<given-names><![CDATA[OJ]]></given-names>
</name>
<name>
<surname><![CDATA[Browett]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
<name>
<surname><![CDATA[Griffin]]></surname>
<given-names><![CDATA[PH]]></given-names>
</name>
<name>
<surname><![CDATA[Ross]]></surname>
<given-names><![CDATA[IK]]></given-names>
</name>
<name>
<surname><![CDATA[Brodribb]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Cooke]]></surname>
<given-names><![CDATA[TJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Appendicitis and mimicking conditions. A prospective study]]></article-title>
<source><![CDATA[Lancet]]></source>
<year>1975</year>
<volume>2</volume>
<page-range>421-4</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ohle]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[O'Reilly]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[O'Brien]]></surname>
<given-names><![CDATA[KK]]></given-names>
</name>
<name>
<surname><![CDATA[Fahey]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Dimitrov]]></surname>
<given-names><![CDATA[BD]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The Alvarado score, for predicting acute appendicitis:a systematic review]]></article-title>
<source><![CDATA[BMC Med]]></source>
<year>2011</year>
<volume>9</volume>
<page-range>139</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Baidya]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Rodrigues]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Rao]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Khan]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evaluation of Alvarado score in acute appendicitis:a prospective study]]></article-title>
<source><![CDATA[The Internet Journal of Surgery]]></source>
<year>2006</year>
<volume>9</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Alvarado]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A practical score for the early diagnosis of acute appendicitis]]></article-title>
<source><![CDATA[Ann Emerg Med]]></source>
<year>1986</year>
<volume>15</volume>
<page-range>557e64</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kalan]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Talbot]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Cunliffe]]></surname>
<given-names><![CDATA[WJ]]></given-names>
</name>
<name>
<surname><![CDATA[Rich]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis:a prospective study]]></article-title>
<source><![CDATA[Ann R Coll Surg Engl]]></source>
<year>1994</year>
<volume>76</volume>
<page-range>418-9</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chong]]></surname>
<given-names><![CDATA[CF]]></given-names>
</name>
<name>
<surname><![CDATA[Adi]]></surname>
<given-names><![CDATA[MI]]></given-names>
</name>
<name>
<surname><![CDATA[Thien]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Suyoi]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Mackie]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Tin]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Development of the RIPASA score:a new appendicitis scoring system for the diagnosis of acute appendicitis]]></article-title>
<source><![CDATA[Singapore Med J]]></source>
<year>2010</year>
<volume>51</volume>
<page-range>220-5</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mayo Ossorio]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Pacheco García]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Vázquez]]></surname>
<given-names><![CDATA[Gallego JM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Abdomen agudo]]></article-title>
<source><![CDATA[Medicine]]></source>
<year>2016</year>
<volume>12</volume>
<page-range>363-79</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Shuaib]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Shuaib]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Fakhra]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
<name>
<surname><![CDATA[Marafi]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Alsharaf]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Behbehani]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis]]></article-title>
<source><![CDATA[World J Emerg Med]]></source>
<year>2017</year>
<volume>8</volume>
<page-range>276-80</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Singla]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Singla]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Singh]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Singla]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A comparison between modified Alvarado score and RIPASA score in the diagnosis of acute appendicitis]]></article-title>
<source><![CDATA[Updates Surg]]></source>
<year>2016</year>
<volume>68</volume>
<page-range>351-5</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mán]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Simonka]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
<name>
<surname><![CDATA[Varga]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Rárosi]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Lázár]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Impact of the Alvarado score on the diagnosis of acute appendicitis:comparing clinical judgment, Alvarado score, and a new modified score in suspected appendicitis:a prospective, randomized clinical trial]]></article-title>
<source><![CDATA[Surg Endosc]]></source>
<year>2014</year>
<volume>28</volume>
<page-range>2398-405</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sooriakumaran]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Lovell]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Brown]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A comparison of clinical judgment vs the modified Alvarado score in acute appendicitis]]></article-title>
<source><![CDATA[Int J Surg]]></source>
<year>2005</year>
<volume>3</volume>
<page-range>49-52</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kollár]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[McCartan]]></surname>
<given-names><![CDATA[DP]]></given-names>
</name>
<name>
<surname><![CDATA[Bourke]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Cross]]></surname>
<given-names><![CDATA[KS]]></given-names>
</name>
<name>
<surname><![CDATA[Dowdall]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Predicting acute appendicitis?A comparison of the Alvarado Score, the Appendicitis Inflammatory Response Score and clinical assessment]]></article-title>
<source><![CDATA[World J Surg]]></source>
<year>2015</year>
<volume>39</volume>
<page-range>104-9</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sinnet]]></surname>
<given-names><![CDATA[PR]]></given-names>
</name>
<name>
<surname><![CDATA[Chellappa]]></surname>
<given-names><![CDATA[PM]]></given-names>
</name>
<name>
<surname><![CDATA[Kumar]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Ethirajulu]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Thambi]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Comparative study on the diagnostic accuracy of the RIPASA score over Alvarado score in the diagnosis of acute appendicitis]]></article-title>
<source><![CDATA[J Evid Based Med Healthc]]></source>
<year>2016</year>
<volume>3</volume>
<page-range>4318-21</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Golden]]></surname>
<given-names><![CDATA[SK]]></given-names>
</name>
<name>
<surname><![CDATA[Harringa]]></surname>
<given-names><![CDATA[JB]]></given-names>
</name>
<name>
<surname><![CDATA[Pickhardt]]></surname>
<given-names><![CDATA[PJ]]></given-names>
</name>
<name>
<surname><![CDATA[Ebinger]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Svenson]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Zhao]]></surname>
<given-names><![CDATA[YQ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prospective evaluation of the ability of clinical scoring systems and physician-determined likelihood of appendicitis to obviate the need for computed tomography]]></article-title>
<source><![CDATA[Emerg Med J]]></source>
<year>2016</year>
<volume>33</volume>
<page-range>458-64</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ozsoy]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
<name>
<surname><![CDATA[Yenidogan]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evaluation of the Alvarado scoring system in the management of acute appendicitis]]></article-title>
<source><![CDATA[Turk J Surg]]></source>
<year>2017</year>
<volume>33</volume>
<page-range>200-4</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Karami]]></surname>
<given-names><![CDATA[MY]]></given-names>
</name>
<name>
<surname><![CDATA[Niakan]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Zadebagheri]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Mardani]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Shayan]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
<name>
<surname><![CDATA[Deilami]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Which one is better?Comparison of the acute inflammatory response, Raja Isteri Pengiran Anak Saleha Appendicitis and Alvarado scoring systems]]></article-title>
<source><![CDATA[Ann Coloproctol]]></source>
<year>2017</year>
<volume>33</volume>
<page-range>227-31</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Díaz-Barrientos]]></surname>
<given-names><![CDATA[CZ]]></given-names>
</name>
<name>
<surname><![CDATA[Aquino-González]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Heredia-Montaño]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Navarro-Tovar]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Pineda-Espinosa]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Espinosa de Santillana]]></surname>
<given-names><![CDATA[IA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Escala RIPASA para el diagnóstico de apendicitis aguda:comparación con la escala de Alvarado modificada]]></article-title>
<source><![CDATA[Rev Gastroenterol Mex]]></source>
<year>2018</year>
<volume>83</volume>
<page-range>112-6</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
