Comparison of pediatric emergency physicians' and surgeons' evaluation and diagnosis of appendicitis
Comparison of pediatric emergency physicians' and surgeons' evaluation and diagnosis of appendicitis
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DOI：
10.1111/j.1553-2712.2008.00029.x
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发表时间：
2008-02-01
影响因子：
4.4
通讯作者：
Bachur, Richard G.
中科院分区：
文献类型：
--
作者：
Kharbanda, Anupam B.;Fishman, Steven J.;Bachur, Richard G.
目的：比较儿科急诊医师 (EP) 和高级外科住院医生之间检查者的可靠性和预测阑尾炎的能力。方法：作者对 3 至 18 岁有可疑阑尾炎体征和症状的儿童进行了一项前瞻性队列研究。患者最初由儿科医生主治，然后由高级外科住院医师进行检查。医生报告是否存在特定的病史和体检结果，并预测患者患有阑尾炎的可能性。比较历史检查结果和体格检查结果的检查者间可靠性（kappa 统计）。计算了儿科 EP 和外科医生预测的阑尾炎分布和中位概率。 结果：作者评估了 350 名急性腹痛患者。历史问题显示不同类型的医生之间存在轻微到非常好的一致性（kappa 统计范围 0.33-0.82），而体检结果显示出较差到一般的一致性（范围 0.14-0.48）。医生预测最终诊断为阑尾炎的患者（75% vs. 70%；p = 0.73）和未诊断为阑尾炎的患者（25% vs. 30%；p = 0.59）的阑尾炎中位概率相似。对于阑尾炎预测概率 >= 90% 的患者子集，儿科 EP 和高级外科住院医师具有相似的准确性（80% 与 79%；p = 0.92）。同样，在患有以下疾病的患者中
Objectives: To compare the interexaminer reliability and ability to predict appendicitis between pediatric emergency physicians (EPs) and senior surgical residents.Methods: The authors conducted a prospective cohort study of children aged 3 to 18 years of age with signs and symptoms suspicious for appendicitis. Patients were initially examined by a pediatric EP attending and then by a consulting senior surgical resident. Physicians reported the presence or absence of specific historical and physical exam findings and predicted the likelihood the patient had appendicitis. Interexaminer reliability of historical and physical exam findings was compared (kappa statistic). Distributions and median probabilities of appendicitis were calculated for pediatric EP and surgeon predictions.Results: The authors evaluated 350 patients with acute abdominal pain. Historical questions revealed slight to very good agreement (kappa statistic range 0.33-0.82) between physician types, whereas physical examination findings exhibited poor to fair agreement (range 0.14-0.48). Physicians predicted similar median probabilities of appendicitis for patients who were ultimately diagnosed with appendicitis (75% vs. 70%; p = 0.73) and patients without appendicitis (25% vs. 30%; p = 0.59). For a subset of patients given a >= 90% predicted probability of appendicitis, pediatric EPs and senior surgical residents had similar accuracy (80% vs. 79%; p = 0.92). Similarly, among patients with