Clinical Importance of the Heel Drop Test and a New Clinical Score for Adult Appendicitis.
Clinical Importance of the Heel Drop Test and a New Clinical Score for Adult Appendicitis.
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DOI：
10.1371/journal.pone.0164574
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Kim WY
中科院分区：
文献类型：
--
作者：
Ahn S;Lee H;Choi W;Ahn R;Hong JS;Sohn CH;Seo DW;Lee YS;Lim KS;Kim WY
我们试图评估足跟跌落试验在疑似阑尾炎患者中的准确性，并试图开发一种新的临床评分，该评分结合了足跟跌落试验和其他参数，用于诊断这种情况。我们对2015年1月至8月期间在两个学术城市急诊科疑似阑尾炎的成人患者进行了前瞻性观察研究。计算了每个参数的预测特性，沿着与足跟跌落试验结果。通过逻辑回归分析生成复合评分。将生成的评分的性能与阿尔瓦拉多评分的性能进行比较。在292例入组患者中，165例（56.5%）患有急性阑尾炎。足跟跌落试验的预测价值高于反跳痛。新（MESH）评分中包括的变量及其评分为疼痛迁移（2）、升高的白色血细胞（WBC）> 10，000/μL（3）、向左移位（2）和阳性足跟跌落试验（3）。MESH评分的AUC高于阿尔瓦拉多评分（0.805 vs. 0.701）。选择5分和11分作为临界值; MESH评分≥5与阿尔瓦拉多评分≥5相比，MESH评分≥8与阿尔瓦拉多评分≥7相比，在诊断阑尾炎方面表现更好。MESH（迁移、WBC升高、左移和足跟跌落试验）是评估疑似阑尾炎患者的简单临床评分系统，比阿尔瓦拉多评分更准确。需要进一步的验证研究。
We tried to evaluate the accuracy of the heel drop test in patients with suspected appendicitis and tried to develop a new clinical score, which incorporates the heel drop test and other parameters, for the diagnosis of this condition. We performed a prospective observational study on adult patients with suspected appendicitis at two academic urban emergency departments between January and August 2015. The predictive characteristics of each parameter, along with heel drop test results were calculated. A composite score was generated by logistic regression analysis. The performance of the generated score was compared to that of the Alvarado score. Of the 292 enrolled patients, 165 (56.5%) had acute appendicitis. The heel drop test had a higher predictive value than rebound tenderness. Variables and their points included in the new (MESH) score were pain migration (2), elevated white blood cell (WBC) >10,000/μL (3), shift to left (2), and positive heel drop test (3). The MESH score had a higher AUC than the Alvarado score (0.805 vs. 0.701). Scores of 5 and 11 were chosen as cut-off values; a MESH score ≥5 compared to an Alvarado score ≥5, and a MESH score ≥8 compared to an Alvarado score ≥7 showed better performance in diagnosing appendicitis. MESH (migration, elevated WBC, shift to left, and heel drop test) is a simple clinical scoring system for assessing patients with suspected appendicitis and is more accurate than the Alvarado score. Further validation studies are needed.
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