Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis
Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis
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DOI：
10.1001/archsurg.136.5.556
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发表时间：
2001-05-01
影响因子：
--
通讯作者：
Ho, HS
中科院分区：
文献类型：
--
作者：
Lee, SL;Walsh, AJ;Ho, HS
假设：计算机断层扫描（CT）和超声检查（US）并不能提高急性阑尾炎的整体诊断准确性。设计：回顾性分析。设置：大学三级保健中心。患者：766例连续患者，从1995年1月1日至1999年12月31日因疑似阑尾炎接受阑尾切除术。主要结果测量：结果：阑尾切除术阴性率为15.7%，阑尾穿孔发生率为14.6%。游走性疼痛史的阳性预测值最高（91%），其次是白细胞增多大于12 x10 °/L（90.1%）、CT（83.8%）和US（81.3%）。CT和US的假阴性率分别为60%和76.1%。急诊室评估的平均± SD为5.2 ± 5.4小时，超声或CT延长了评估时间（分别为6.4 ± 74小时和7.8 ± 10.8小时）。急诊室评估的持续时间不影响穿孔率，但有术后并发症的患者的评估时间（平均值± SD，8.0 ± 12.7 h）长于无术后并发症的患者（4.8 ± 3.3 h）（P= 0.04）。死亡率为9.1%，非穿孔病例为6.4%，穿孔病例为19.8%。76例患者行腹腔镜阑尾切除术，阴性阑尾切除率为42.1%，而开腹阑尾切除术为15.4%（P <0.001）。腹腔镜检查，然而，有最低的发病率（1.3%），并正确识别异常的91.6%的患者有一个正常的appendice.Conclusions：迁移性疼痛，体检，和初始白细胞增多仍然是可靠和准确的诊断急性阑尾炎。CT和US都不能提高诊断的准确性或阴性阑尾切除率;事实上，它们可能会延迟外科会诊和阑尾切除术。在非典型病例中，应考虑选择性使用诊断性腹腔镜检查。
Hypothesis: Computed tomography (CT) and ultrasonography (US) do not improve the overall diagnostic accuracy for acute appendicitis.Design: Retrospective review.Setting: University tertiary care center.Patients: Seven hundred sixty-six consecutive patients undergoing appendectomy for suspected appendicitis from January 1, 1995, to December 31, 1999.Main Outcome Measures: Epidemiology of acute appendicitis and the roles of clinical assessment, CT, US, and laparoscopy.Results: The negative appendectomy rate was 15.7%, and the incidence of perforated appendicitis was 14.6%. A history of migratory pain had the highest positive predictive value (91%), followed by leukocytosis greater than 12x10 degrees /L (90.1%), CT (83.8%), and US (81.3%). The false-negative rates were 60% for CT and 76.1% for US. Emergency department evaluation took a mean +/- SD of 5.2 +/-5.4 hours and was prolonged by US or CT (6.4 +/- 74 h and 7.8 +/- 10.8 h, respectively). The duration of emergency department evaluation did not affect the perforation rate, but patients with postoperative complications had longer evaluations (mean +/- SD, 8.0 +/- 12.7 h) than did those without (4.8 +/-3.3 h) (P=.04). Morbidity was 9.1%, 6.4% for nonperforated cases and 19.8% for perforated cases. Seventy-six patients had laparoscopic appendectomy, with a negative appendectomy rate of 42.1%, compared with 15.4% for open appendectomy (P < .001). Laparoscopy, however, had minimal morbidity (1.3%) and correctly identified the abnormality in 91.6% of patients who had a normal-appearing appendix.Conclusions: Migratory pain, physical examination, and initial leukocytosis remain reliable and accurate in diagnosing acute appendicitis. Neither CT nor US improves the diagnostic accuracy or the negative appendectomy rate; in fact, they may delay surgical consultation and appendectomy. In atypical cases, one should consider the selective use of diagnostic laparoscopy instead.