Zielke A, Sitter H, Rampp T, Bohrer T, Rothmund M
Department of Surgery, Philipps-University of Marburg, Baldingerstrasse, PO Box 100, 35033 Marburg, Germany.
World J Surg. 2001 May;25(5):578-84. doi: 10.1007/s002680020078.
Diagnosing acute appendicitis (aA) remains difficult. This study evaluated the utility of ultrasonography (US) compared to clinical decision-making alone and scoring systems to establish the indication for laparotomy in patients in whom aA was suspected. The prospectively documented data of 2209 patients admitted for suspicion of aA, who underwent US by one of 12 surgeons, formed a database in which the diagnostic and procedural performance of clinical decision-making, US, two scoring systems (Ohmann and Eskelinen scores), and clinical algorithms taking account of clinical and either US findings or score results, were retrospectively evaluated. The results of either modality were correlated with final diagnoses obtained by laparotomy in 696 patients, of whom 540 had aA (prevalence 24.45%) and follow-up data in the remainder. US had the highest specificity (97%, compared to 93% for the Ohmann and Eskelinen scores and 94% for the clinical evaluation and algorithms) and lowest overall rate of false-positive findings (negative laparotomy rate 7.6%). The scores were accurate in refuting the diagnosis of aA but otherwise not superior to US. The best overall diagnostic and procedural results were obtained with the algorithms that combined the results of either US or the Ohmann score with clinical evaluation, which produced the most favorable numbers of negative laparotomies, potential perforations, and missed cases of aA. US is the diagnostic standard of reference for patients with a possible diagnosis of aA. It yields diagnostic results superior to those of scoring systems and provisional clinical evaluation. However, the benefits of US by ultrasonographically trained surgeons are only fully appreciated within the context of clinical algorithms. The joint evaluation of score results and clinical evaluation may deliver information of similar accuracy.
诊断急性阑尾炎（aA）仍然具有挑战性。本研究评估了超声检查（US）相较于单纯临床决策及评分系统在确定疑似aA患者剖腹手术指征方面的效用。对2209例因疑似aA入院、由12位外科医生之一进行超声检查的患者的前瞻性记录数据形成了一个数据库，在该数据库中，对临床决策、超声检查、两种评分系统（奥曼评分和埃斯凯林评分）以及考虑临床和超声检查结果或评分结果的临床算法的诊断和操作性能进行了回顾性评估。两种检查方式的结果均与696例接受剖腹手术患者的最终诊断相关，其中540例患有aA（患病率24.45%），其余患者有随访数据。超声检查具有最高的特异性（97%，奥曼评分和埃斯凯林评分为93%，临床评估和算法为94%）以及最低的总体假阳性率（阴性剖腹手术率7.6%）。这些评分在排除aA诊断方面是准确的，但在其他方面并不优于超声检查。将超声检查或奥曼评分结果与临床评估相结合的算法获得了最佳的总体诊断和操作结果，产生了最有利的阴性剖腹手术、潜在穿孔和aA漏诊病例数。超声检查是疑似aA患者的诊断参考标准。它产生的诊断结果优于评分系统和临时临床评估。然而，只有在临床算法的背景下，经过超声检查培训的外科医生才能充分认识到超声检查的益处。评分结果与临床评估的联合评估可能提供准确性相似的信息。
