Has misdiagnosis of appendicitis decreased over time? A population-based analysis
Has misdiagnosis of appendicitis decreased over time? A population-based analysis
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DOI：
10.1001/jama.286.14.1748
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发表时间：
2001-10-10
影响因子：
120.7
通讯作者：
Dellinger, EP
中科院分区：
文献类型：
--
作者：
Flum, DR;Morris, A;Dellinger, EP
误诊为阑尾炎是一种不良后果，导致不必要的手术。计算机断层扫描，超声检查和腹腔镜已被建议用于阑尾炎的可疑症状的患者，以减少不必要的surgical. ObjectiveTo确定是否有频率的误诊阑尾切除术前减少与计算机断层扫描，超声检查和腹腔镜的可用性增加。一项基于人群的队列研究，数据来自华盛顿州立医院出院数据库，涉及85790名被指定为国际疾病分类第九次修订版阑尾切除术程序代码的居民，和美国人口普查局1987- 1998年的数据。主要结果测量急性阑尾炎阑尾切除术的年龄和性别标准化发病率结果在63707例非意外阑尾切除术患者中，84.5%有阑尾炎（25.8%有穿孔），15.5%无阑尾炎相关诊断。在调整了年龄和性别后，不必要的阑尾切除术和阑尾炎穿孔的人群发病率没有随时间发生显著变化。在育龄妇女中，基于人口的误诊率每年增加1%（P = 0.005）。65岁以上患者的误诊率每年增加8%（P
Context Misdiagnosis of presumed appendicitis is an adverse outcome that leads to unnecessary surgery. Computed tomography, ultrasonography, and laparoscopy have been suggested for use in patients with equivocal signs of appendicitis to decrease unnecessary surgery.Objective To determine if frequency of misdiagnosis preceding appendectomy has decreased with increased availability of computed tomography, ultrasonography, and laparoscopy.Design, Setting, and Patients Retrospective, population-based cohort study of data from a Washington State hospital discharge database for 85790 residents assigned International Classification of Diseases, Ninth Revision procedure codes for appendectomy, and United States Census Bureau data for 1987-1998.Main Outcome Measure Population-based age- and sex-standardized incidence of appendectomy with acute appendicitis (perforated or not) or with a normal appendix.Results Among 63707 nonincidental appendectomy patients, 84.5% had appendicitis (25.8% with perforation) and 15.5% had no associated diagnosis of appendicitis. After adjusting for age and sex, the population-based incidence of unnecessary appendectomy and of appendicitis with perforation did not change significantly over time. Among women of reproductive age, the population-based incidence of misdiagnosis increased 1% per year (P =.005). The incidence of misdiagnosis increased 8% yearly in patients older than 65 years (P