A new approach to accurate diagnosis of acute appendicitis
A new approach to accurate diagnosis of acute appendicitis
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DOI：
10.1007/s00268-005-7853-6
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发表时间：
2005-09-01
影响因子：
2.6
通讯作者：
Nikiteas, NI
中科院分区：
文献类型：
--
作者：
Tzanakis, NE;Efstathiou, SP;Nikiteas, NI
本研究旨在（1）开发一种简单的评分系统，结合超声（US）检查和临床或实验室预测因素，以提高急性阑尾炎（AA）的诊断准确性，以及（2）与先前模型相比，评价评分系统的性能。在多变量分析中考虑了15个变量，包括对疑似AA患者的US评估，使用手术时AA的发现作为终点（内部研究）。将新评分与之前的评分一起应用于疑似AA受试者的前瞻性独立人群，并比较各自的表现（外部验证研究）。在内部研究的303例患者（170例男性，平均年龄28.3 ± 13.3岁）中，161例继续手术，130例在手术时患有AA。确定了AA的四个独立相关性，并用于推导以下基于整数的评分系统：US显示AA的点数= 6+右下象限压痛的点数= 4+反跳痛的点数= 3+白细胞计数> 12，000/μ l的点数= 2。在外部研究中（201例受试者，105例男性，平均年龄28.7 ± 11.9岁，109例手术，87例AA），当临界值为：AA使用8分，拟定评分的敏感性、特异性、准确性和曲线下面积分别为95.4%、97.4%、96.5%和93%，远远超过了以往的车型。拟定的评分系统引入了临床评价与超声成像和炎症反应标志物的定量组合，这可能会提高疑似AA受试者的诊断准确性，尤其是在无法随时进行24小时CT扫描的地理区域。
This study aimed (1) to develop a simple scoring system incorporating ultrasound (US) examination and clinical or laboratory predictors for increasing diagnostic accuracy in acute appendicitis (AA), and (2) to evaluate the performance of the scoring system as compared to that of previous models. Fifteen variables including US assessment for patients admitted with suspected AA were considered in multivariate analysis using the finding of AA at operation as the end point (internal study). The new score, together with It previous ones, was applied to a prospective independent population of subjects with suspected AA, and the respective performances were compared (external validation study). Among 303 patients (170 males, mean age 28.3 +/- 13.3 years) of the internal study, 161 went on to surgery, and 130 had AA at operation. Four independent correlates of AA were identified and used for the derivation of the following integer-based scoring system: number of points = 6 for US demonstrating AA + 4 for tenderness in the right lower quadrant + 3 for rebound tenderness + 2 for leukocyte count > 12,000/mu l. In the external study (201 subjects, 105 males, mean age 28.7 +/- 11.9 years, 109 operated, 87 with AA), when the cut-off of : 8 points for AA was used, sensitivity, specificity, accuracy, and area under the curve of the proposed score were 95.4%, 97.4%, 96.5%, and 93%, respectively, exceeding noticeably the previous models. The proposed scoring system introduces a quantitative combination of the clinical evaluation with US imaging and a marker of inflammatory response, which may enhance the diagnostic accuracy for subjects with suspected AA especially in geographical areas where CT scanning is not readily available on a 24-hour basis.