Prospective Validation of Two Systems of Classification for the Diagnosis of Acute Appendicitis
Prospective Validation of Two Systems of Classification for the Diagnosis of Acute Appendicitis
复制标题
DOI：
10.1097/pec.0b013e31820d6460
复制
发表时间：
2011-03-01
影响因子：
1.4
通讯作者：
Luaces Cubells, Carlos
中科院分区：
文献类型：
--
作者：
Escriba, Alexandre;Maria Gamell, Anna;Luaces Cubells, Carlos
目的：本研究的目的是（1）验证阿尔瓦拉多评分和小儿阑尾炎评分（PAS）在一个前瞻性确定的儿科队列和（2）评估腹部超声检查（AUS）作为一种工具，以增加两个scores.Patients和方法的诊断可靠性：前瞻性研究进行了2008年1月10日至2009年1月1日。所有在急诊科就诊的疑似急性阑尾炎（AA）患者均采集了血液样本。记录了两个评分中的项目。AUS的表现、患者入院的决定和治疗方法由医生决定，不考虑评分值。非入院患者通过电话联系。结果：99例患者被纳入。平均年龄为11岁，62.6%为男性。44.4%的患者行膀胱切除术。阿尔瓦拉多评分的受试者工作特征曲线下面积为0.96，PAS评分的受试者工作特征曲线下面积为0.97。阿尔瓦拉多评分小于5分或PAS评分小于4分的患者均未发生AA。所有阿尔瓦拉多评分大于8或PAS大于7的患者均患有AA。两种评分的最佳临界点均为6（阿尔瓦拉多评分的敏感性为90.4%，特异性为91.2%，PAS评分的敏感性为88.1%，特异性为98.2%）。腹部超声检查31例，敏感性84.6%，特异性94.4%。我们一起研究了分数和AUS的价值。假设阿尔瓦拉多评分为1 ~ 4分，PAS评分为1 ~ 3分为无AA，阿尔瓦拉多评分为9 ~ 10分，PAS评分为8 ~ 9分为AA，并根据AUS对中间值进行处理，获得的敏感性分别为93.3%和97.2%，特异性分别为100%和97.6%。这两个分数是一个有用的工具，在评估儿童与可能的AA。对于分数的极端值，结果确实确保了它们在急诊科的使用。AUS可以帮助中间值的决策。
Objectives: The objectives of this study were (1) to validate the Alvarado score and pediatric appendicitis score (PAS) in a prospectively identified pediatric cohort and (2) to assess abdominal ultrasonography (AUS) as a tool to increase the diagnostic reliability of both scores.Patients and Methods: Prospective study conducted from January 10, 2008, to January 1, 2009. All patients attended at the emergency department with suspected acute appendicitis (AA) who had a blood sample collected were included. Items from both scores were recorded. The performance of an AUS, the decision to admit the patient, and the therapeutics were decided by the physician, disregarding the scores values. Nonadmitted patients were contacted by telephone.Results: Ninety-nine patients were included. Mean age was 11 years, and 62.6% were males. Appendectomy was performed in 44.4% patients. The area under the receiver operating characteristic curve for the Alvarado score was 0.96 and that for PAS was 0.97. Not a single patient with an Alvarado score less than 5 or PAS less than 4 had AA. All patients with an Alvarado score greater than 8 or PAS greater than 7 had AA. For both scores, the optimum cutoff point was 6 (sensibility of 90.4% and specificity of 91.2% for the Alvarado score and sensibility of 88.1% and specificity of 98.2% for PAS). Abdominal ultrasonography was performed on 31 patients (sensibility of 84.6% and specificity of 94.4%). We studied the value of scores and AUS together. Assuming an Alvarado score from 1 to 4 and PAS from 1 to 3 as no AA, an Alvarado score from 9 to 10 and PAS from 8 to 9 as AA, and proceeding according to the AUS for intermediate values, a sensibility of 93.3% and 97.2% and a specificity of 100% and 97.6%, respectively, were obtained.Conclusions: Both scores are a useful tool in the evaluation of children with possible AA. For extreme values of scores, the results really ensure their use in the emergency department. The AUS can help on decision making for intermediate values.