Poor Sensitivity of a Modified Alvarado Score in Adults With Suspected Appendicitis
Poor Sensitivity of a Modified Alvarado Score in Adults With Suspected Appendicitis
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DOI：
10.1016/j.annemergmed.2013.01.021
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发表时间：
2013-08-01
影响因子：
6.2
通讯作者：
Mills, Angela M.
中科院分区：
文献类型：
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作者：
Meltzer, Andrew C.;Baumann, Brigitte M.;Mills, Angela M.
研究目的：确定阑尾炎低风险患者的临床决策规则可能会减少对CT诊断的依赖。我们寻求前瞻性地评估低改良Alvarado评分在急诊科(ED)可疑阑尾炎患者中的准确性，并将该评分与临床判断进行比较。我们假设，较低的改良Alvarado评分将具有足够高的敏感性来排除急性阑尾炎。方法：我们在2个学术城市急诊室对疑似阑尾炎的成年患者进行了前瞻性观察研究。低改良Alvarado评分定义为<4分。以95%可信区间(CI)计算低改良Alvarado评分的敏感度和特异度，并通过CT、剖腹手术或7天随访确诊为阑尾炎。结果：261例患者进入分析，平均年龄35岁[18~岁，女性68%，白人52%]。53例(20%)为急性阑尾炎。改良的Alvarado评分试验的敏感性和特异性分别为72%(95%CI 58%~84%)和54%(95%CI 47%~61%)。非结构化临床判断诊断为阑尾炎的敏感性和特异性分别为93%(95%可信区间82%~98%)和33%(95%可信区间27%~40%)。结论：改良Alvarado评分在排除急性阑尾炎方面的敏感性为72%，低于临床判断。
Study objective: A clinical decision rule that identifies patients at low risk for appendicitis may reduce the reliance on computed tomography (CT) for diagnosis. We seek to prospectively evaluate the accuracy of a low modified Alvarado score in emergency department (ED) patients with suspected appendicitis and compare the score to clinical judgment. We hypothesize that a low modified Alvarado score will have a sufficiently high sensitivity to rule out acute appendicitis.Methods: We performed a prospective observational study of adult patients with suspected appendicitis at 2 academic urban EDs. A low modified Alvarado score was defined as less than 4. The sensitivity and specificity were calculated with 95% confidence interval (CI) for a low modified Alvarado score, and a final diagnosis of appendicitis was confirmed by CT, laparotomy, or 7-day follow-up.Results: Two hundred sixty-one patients were included for analysis (mean age 35 years [range 18 to 89 years], 68% female patients, 52% white). Fifty-three patients (20%) had acute appendicitis. The modified Alvarado score test characteristics demonstrated a sensitivity and specificity of 72% (95% CI 58% to 84%) and 54% (95% CI 47% to 61%), respectively. Unstructured clinical judgment that appendicitis was either the most likely or second most likely diagnosis demonstrated a sensitivity and specificity of 93% (95% CI 82% to 98%) and 33% (95% CI 27% to 40%), respectively.Conclusion: With a sensitivity of 72%, a low modified Alvarado score is less sensitive than clinical judgment in excluding acute appendicitis.