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In a message dated 12/07/96 19:04:33, Armando writes: >A hundred percent in agreement with this. The point is, the positive >predictive value of a correct history and physical examination is still >better than many tests, and most of the touchy gestures such as >rectal/vaginal examinations may often alter our management. I thought that there was a computer algorithm written by someone from my part of the world (Beighton, S. Yorks UK) that was a better predictor of acute appendicits on history and examination than doctors, does anyone know if the computer programme asked for the result of rectal/vaginal examination ? If not, why do we ever do them in acute appendicitis ( I would be prepared to stand up in court and quote the programme/protocol if I am correct. Anyone who wants to look up the reference, the author was Professor De Dombal, I don't have the details.) Are you saying that history and simple physical examination are all one needs and the intimate examination is irrelevant tothe decision to refer? I would agree with a comment on this thread that the result of the VE/PR in acute abdominal pain is not going to influence management, if there is a chance that it is an ectopic pregnancy, I would'nt do a VE to find out, if the choice is between appendix and pelvic inflammatory disease then the appendix wins (i.e. off to the surgeons and let them decide). A question; Intimate examinations in acute abdominal pain are the remit of secondary care, if it's not acute then a chaparone can be arranged - discuss Trefor Roscoe Email; [log in to unmask] Beighton Health Centre Tel 0114 - 269 5061 Queens Road, Beighon Fax 0114 - 269 7186 Sheffield S19 6BJ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%