Meta-analysis of the clinical and laboratory diagnosis of appendicitis
Meta-analysis of the clinical and laboratory diagnosis of appendicitis
复制标题
DOI：
10.1002/bjs.4464
复制
发表时间：
2004-01-01
影响因子：
9.6
通讯作者：
Andersson, REB
中科院分区：
文献类型：
--
作者：
Andersson, REB
背景：阑尾炎临床诊断中特异性因素的重要性存在争议。这篇综述分析了病史，临床表现和实验室检查结果的元素在疑似appendiclein.Methods的诊断价值：一个系统的Medline搜索所有已发表的研究阑尾炎的临床和实验室诊断的患者入院疑似疾病。荟萃分析的受试者-操作者特征（ROC）的领域，积极和消极的似然比，28诊断变量中描述的24项研究。炎症反应变量（粒细胞计数、多形性血细胞比例、白色血细胞计数和C-反应蛋白浓度），腹膜刺激描述符（反跳和叩击痛，守卫和僵硬）和疼痛迁移是最强的鉴别器，ROC面积为0-78至0.68。炎症变量的区分能力对于穿孔性阑尾炎特别强，ROC面积为0.85至0.87。当两个或两个以上的炎症变量增加，不太可能时，所有都是normal.Conclusion：虽然所有的临床和实验室变量是弱判别单独，他们结合起来时，实现了较高的判别力。炎症反应的实验室检查、腹膜刺激的临床描述和疼痛迁移史是最重要的诊断信息，应包括在任何诊断评估中。
Background: The importance of specific elements in the clinical diagnosis of appendicitis is controversial. This review analyses the diagnostic value of elements of disease history, clinical findings and laboratory test results in suspected appendicitis.Methods: A systematic Medline search was made of all published studies on the clinical and laboratory diagnosis of appendicitis in patients admitted to hospital with suspected disease. Meta-analyses of receiver-operator characteristic (ROC) areas, and positive and negative likelihood ratios, of 28 diagnostic variables described in 24 studies are presented.Results: Inflammatory response variables (granulocyte count, proportion of polymorphonuclear blood cells, white blood cell count and C-reactive protein concentration), descriptors of peritoneal irritation (rebound and percussion tenderness, guarding and rigidity) and migration of pain were the strongest discriminators, with ROC areas of 0-78 to 0.68. The discriminatory power of the inflammatory variables was particularly strong for perforated appendicitis, with ROC areas of 0.85 to 0.87. Appendicitis was likely when two or more inflammatory variables were increased and unlikely when all were normal.Conclusion: Although all clinical and laboratory variables are weak discriminators individually, they achieve a high discriminatory power when combined. Laboratory examination of the inflammatory response, clinical descriptors of peritoneal irritation, and a history of migration of pain yield the most important diagnostic information and should be included in any diagnostic assessment.