Evaluation of appendicitis risk prediction models in adults with suspected appendicitis
Evaluation of appendicitis risk prediction models in adults with suspected appendicitis
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DOI：
10.1002/bjs.11440
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发表时间：
2020-01-01
影响因子：
9.6
通讯作者：
Bhangu, A.
中科院分区：
文献类型：
--
作者：
Nepogodiev, D.;Matthews, J. H.;Bhangu, A.
背景：阑尾炎是全世界最常见的普外科急症，但其诊断仍具有挑战性。本研究的目的是确定现有的风险预测模型是否可以可靠地识别患者提出在英国医院急性右髂窝（RIF）疼痛谁是在低风险的appendicles.Methods：一个系统的搜索完成，以确定所有现有的阑尾炎风险预测模型。使用来自一项国际前瞻性队列研究的英国数据对模型进行了验证，该研究采集了2017年3月至6月因急性RIF住院的16-45岁连续患者。主要结果是最佳可实现的模型特异性（未患阑尾炎的患者被正确归类为低风险的比例），同时将失败率保持在5%以下（确定为低风险的患者实际患有阑尾炎的比例）。在英国154家医院中，约有5345名患者被确定，其中三分之二（5345人中的3613人，67.6%）是女性。女性接受手术切除组织学正常阑尾的可能性（964人中的272人，28.2%）是男性（993人中的120人，12.1%）的两倍多（相对风险2.33，95% CI）。1.92至2.84; P
Background: Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis.Methods: A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16-45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis).Results: Some 5345 patients across 154 UK hospitals were identified, of which two-thirds (3613 of 5345, 67.6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28.2 per cent) than men (120 of 993, 12.1 per cent) (relative risk 2.33, 95 per cent c.i. 1.92 to 2.84; P