Diagnostic value of disease history, clinical presentation, and inflammatory parameters of appendicitis
Diagnostic value of disease history, clinical presentation, and inflammatory parameters of appendicitis
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DOI：
10.1007/pl00013174
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发表时间：
1999-02-01
影响因子：
2.6
通讯作者：
Olaison, GP
中科院分区：
文献类型：
--
作者：
Andersson, RE;Hugander, AP;Olaison, GP
阑尾炎的临床诊断需要改进，因为高达40%的疑似阑尾炎的探查是不必要的。使用体温和实验室检查作为诊断辅助手段在这些患者的管理是有争议的。这些变量的诊断能力相比，疾病史和临床表现没有得到很好的研究。在这项研究中，我们前瞻性地评估和比较了496例疑似阑尾炎患者的病史、临床表现、体温和实验室检查等21项要素的诊断价值。从受试者工作特征（ROC）曲线下面积和似然比（LR）比较每个变量的诊断价值。采用Logistic回归分析各变量组合的诊断价值及独立关系。没有一个单一的变量有足够高的鉴别力或预测力来作为一个真正的诊断测试。炎症变量（体温、白细胞和分类白色血细胞（WBC）计数、C-反应蛋白）的鉴别和预测能力与临床结果（直接和反跳性腹部压痛和保护）相似。厌食、恶心和右侧直肠压痛没有诊断价值。白细胞和白细胞分类计数、C反应蛋白、反跳痛、警戒和性别是阑尾炎的独立预测因子，其合并ROC面积为0.93。这表明炎症变量包含重要的诊断信息，特别是对于晚期阑尾炎。因此，它们应始终包括在诊断检查疑似阑尾炎患者。
The clinical diagnosis of appendicitis needs to be improved, as up to 40% of explorations for suspected appendicitis are unnecessary. The use of body temperature and laboratory examinations as diagnostic aids in the management of these patients is controversial. The diagnostic power of these variables compared to that of the disease history and clinical findings is not well studied. In this study we prospectively assessed and compared the diagnostic value of 21 elements of the history, clinical findings, body temperature, and laboratory examinations in 496 patients with suspected appendicitis. The diagnostic value of each variable was compared from the area under the receiver operating characteristic (ROC) curve and the likelihood ratios (LR). Logistic regression was used to analyze the diagnostic value of a combination of variables and to analyze independent relations. No single variable had sufficiently high discriminating or predicting power to be used as a true diagnostic test. The inflammatory variables (temperature, leukocyte and differential white blood cell (WBC) counts, C-reactive protein) had discriminating and predicting powers similar to those of the clinical findings (direct and rebound abdominal tenderness and guarding). Anorexia, nausea, and right-sided rectal tenderness had no diagnostic value. The leukocyte and differential WBC counts, C-reactive protein, rebound tenderness, guarding, and gender were independent predictors of appendicitis with a combined ROC area of 0.93 for appendicitis. This showed that inflammatory variables contain important diagnostic information, especially with advanced appendicitis. They should therefore always be included in the diagnostic workup in patients with suspected appendicitis.