Zielke A, Sitter H, Rampp T, Schäfer E, Möbius E, Lorenz W, Rothmund M
Klinik für Ailgemeinchirurgie, Philipps-Universität Marburg.
Dtsch Med Wochenschr. 1999 May 7;124(18):545-50. doi: 10.1055/s-2007-1024357.
To assess two recently developed scoring systems with respect to making or excluding the diagnosis of acute appendicitis.
Data on 2359 patients with typical signs of acute appendicitis (AA) were analysed, the results of two diagnostic scoring systems being compared with the diagnosis made by an experienced surgeon.
AA was confirmed in 662 of the 22,359 patients (prevalence 28%). Sensitivity, specificity, positive and negative predictive values and overall accuracy for diagnosis with the Ohmann scoring system were 0.63, 0.93, 0.77, 0.86 and 0.84; with the Eskelinen score the values were 0.79, 0.85, 0.68, 0.81 and 0.835; and by the surgeon they were 0.90, 0.94, 0.85, 0.96 und 0.93. The negative appendectomy or laparotomy rate was 14.3 an 12.3 respectively with the Ohmann score, 29.5 and 26.6 with the Eskelinen score. The numbers of potential and of nondiagnosed perforations were 41% and 37% respectively with the Ohman score and 26.6% and 16.3% with the Eskelinen score. The number of missed cases of AA was lowest with the Ohman scoring system, compared with 1.8% for the surgeon. After excluding AA, both scoring systems had a specificity of -0.99, with a positive probability rate of at least 27 (Eskelinen score) up to 87 (Ohman score).
Both diagnostic scoring systems are better for excluding than correctly diagnosing AA; the decision to exclude could be made with a high degree of accuracy. Either scoring system may therefore be used in primary care of patients suspected of AA to help decide on referral to hospital.
评估两种最近开发的评分系统在急性阑尾炎诊断或排除诊断方面的表现。
分析了2359例有典型急性阑尾炎（AA）体征患者的数据，将两种诊断评分系统的结果与经验丰富的外科医生所做的诊断进行比较。
在2359例患者中，662例确诊为AA（患病率28%）。Ohmann评分系统诊断的敏感性、特异性、阳性和阴性预测值及总体准确率分别为0.63、0.93、0.77、0.86和0.84；Eskelinen评分的值分别为0.79、0.85、0.68、0.81和0.835；外科医生诊断的相应值分别为0.90、0.94、0.85、0.96和0.93。Ohmann评分时阴性阑尾切除术或剖腹手术率分别为14.3%和12.3%，Eskelinen评分时为29.5%和26.6%。Ohmann评分时潜在穿孔和未诊断穿孔的比例分别为41%和37%，Eskelinen评分时为26.6%和16.3%。Ohmann评分系统漏诊AA的病例数最少，与外科医生的1.8%相比。排除AA后，两种评分系统的特异性均为 -0.99，阳性概率率至少为27（Eskelinen评分）至87（Ohmann评分）。
两种诊断评分系统在排除AA方面比正确诊断更好；排除诊断的决策可以高度准确地做出。因此，两种评分系统均可用于疑似AA患者的初级护理，以帮助决定是否转诊至医院。
