Negative appendicectomy rate as a quality metric in the management of appendicitis: impact of computed tomography, Alvarado score and the definition of negative appendicectomy
Negative appendicectomy rate as a quality metric in the management of appendicitis: impact of computed tomography, Alvarado score and the definition of negative appendicectomy
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DOI：
10.1308/003588412x13171221592131
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发表时间：
2012-09-01
影响因子：
1.4
通讯作者：
Matari, H.
中科院分区：
文献类型：
--
作者：
Mariadason, J. G.;Wang, W. N.;Matari, H.
阑尾切除阴性率（NAR）是阑尾炎治疗的质量指标。虽然计算机断层扫描（CT）与低NAR相关，但Alvarado评分产生可接受的NAR。阴性阑尾切除术的定义可能影响NAR。本研究考察了CT、Alvarado评分和定义对NAR的影响。方法回顾性分析1996 ~ 2010年1306例急诊阑尾切除术患者资料。建立了3个5年队列（队列A: 1996-2000，队列B: 2001-2005，队列C: 2006-2010），并根据阑尾切除术阴性的两种定义计算每个队列的NAR：无炎症（NAR- std）和无内膜中性粒细胞（NAR- str）。结果当阑尾切除术阴性定义改变时，队列A的NAR从9.2%上升到15.8% (p=0.0097)，队列B从2.8%上升到8.6% (p=0.0180) (CT率：80.6%)，队列C从3.0%上升到6.7% (p=0.0255) （CT率：92.4%）。CT的引入降低了1996-2000年（9.2%）和2001-2010年（2.9%）的NAR- std，但2001-2010年CT率的增加对NAR没有影响。Alvarado评分阳性预测值（98.60%）与CT阳性预测值（99.03%）相似。结论阑尾阴性切除术的定义决定了NAR。无论定义如何，CT均可降低NAR，但对于Alvarado评分阳性的男性患者，无需常规CT检查。早期/轻度阑尾炎无需手术即可解决，CT可能导致不必要的手术。Alvarado评分允许选择性地使用CT诊断疑似阑尾炎。
INTRODUCTION The negative appendicectomy rate (NAR) is a quality metric in the management of appendicitis. While computed tomography (CT) has been associated with a low NAR, Alvarado scoring produces an acceptable NAR. The definition of negative appendicectomy may affect the NAR. This study examined the impact of CT, Alvarado score and definition on the NAR.METHODS The charts of 1,306 emergency appendicectomy patients from 1996 to 2010 were reviewed. Three five-year cohorts were created (Cohort A: 1996-2000, Cohort B: 2001-2005, Cohort C: 2006-2010) and the NAR was calculated for each cohort using two definitions of negative appendicectomy: absence of inflammation (NAR-STD) and absence of intramural neutrophils (NAR-STR). NAR-STD was correlated to the CT rate for Cohorts B and C and also to Alvarado score for Cohort C.RESULTS When the definition of negative appendicectomy was changed, the NAR rose from 9.2% to 15.8% (p=0.0097) for Cohort A, from 2.8% to 8.6% (p=0.0180) for Cohort B (CT rate: 80.6%) and from 3.0% to 6.7% (p=0.0255) for Cohort C (CT rate: 92.4%). The introduction of CT lowered NAR-STD from 1996-2000 (9.2%) to 2001-2010 (2.9%) but increasing the CT rate from 2001-2010 had no impact on the NAR. The positive predictive value for Alvarado score (98.60%) and CT (99.03%) were similar.CONCLUSIONS The definition of a negative appendicectomy determines the NAR. CT reduces the NAR regardless of definition but routine CT is unnecessary for male patients with positive Alvarado scores. Early/mild appendicitis may resolve without surgery and CT may contribute to unnecessary surgery. Alvarado scoring allows selective use of CT in suspected appendicitis.