Lessin M S, Chan M, Catallozzi M, Gilchrist M F, Richards C, Manera L, Wallach M T, Luks F I
Division of Pediatric Surgery, Brown University School of Medicine and Hasbro Children's Hospital, Providence, Rhode Island, USA.
Am J Surg. 1999 Mar;177(3):193-6. doi: 10.1016/s0002-9610(99)00002-1.
To evaluate the role of ultrasonography in children with equivocal signs of acute appendicitis, and correlate with initial clinical impression and pathological findings.
This is a prospective evaluation of all children presenting with a possible diagnosis of appendicitis during a 14-month study period. Patients with unequivocal clinical signs of appendicitis underwent appendectomy without ultrasonography. Patients with equivocal signs had documentation of the clinical impression and subsequent abdominal ultrasound. Statistical analysis of results was performed using the chi-square test (P <0.05 significant).
Two hundred fifteen consecutive children were enrolled. Signs were unequivocal in 116 and equivocal in 99. Seven patients in the first group had a normal appendix at operation. Of the 99 patients with equivocal signs, there were 28 true positives, 3 false positives, 64 true negatives, and 4 false negatives. In equivocal cases, sensitivity of the initial clinical impression versus ultrasound was 50% and 88%, respectively (P <0.05). Specificity was 85% and 96%, respectively. The positive and negative predictive values improved from 63% to 90% and 78% to 94%, respectively, with the use of ultrasonography.
The low false positive rate (6%) in clinically obvious cases of appendicitis does not, in our opinion, warrant ultrasonography. In clinically equivocal cases, ultrasonography is a fast, sensitive, and specific diagnostic modality to diagnose or rule out appendicitis, avoiding the need for prolonged observation and/or hospitalization.
评估超声检查在急性阑尾炎体征不明确儿童中的作用，并与初始临床印象和病理结果相关联。
这是一项对在14个月研究期间所有可能诊断为阑尾炎的儿童进行的前瞻性评估。阑尾炎临床体征明确的患者未进行超声检查即接受了阑尾切除术。体征不明确的患者记录了临床印象并随后进行了腹部超声检查。使用卡方检验对结果进行统计分析（P<0.05具有统计学意义）。
连续纳入215名儿童。116名体征明确，99名体征不明确。第一组中有7名患者手术时阑尾正常。在99名体征不明确的患者中，有28例假阳性、3例假阴性、64例真阴性和4例假阳性。在体征不明确的病例中，初始临床印象与超声检查的敏感性分别为50%和88%（P<0.05）。特异性分别为85%和96%。使用超声检查后，阳性和阴性预测值分别从63%提高到90%和从78%提高到94%。
在我们看来，阑尾炎临床明显病例中低假阳性率（6%）并不需要进行超声检查。在临床体征不明确的病例中，超声检查是一种快速、敏感且特异的诊断方法，可用于诊断或排除阑尾炎，避免长时间观察和/或住院。
