van den Broek Wim T, Bijnen Bart B, Rijbroek Bram, Gouma Dirk J
Department of Surgery, Medical Centre Alkmaar, The Netherlands.
Eur J Surg. 2002;168(6):349-54. doi: 10.1080/11024150260284860.
To develop a reproducible scoring system to identify patients who present with a doubtful diagnosis of appendicitis and who would benefit from diagnostic laparoscopy.
Prospective observational study.
Regional teaching hospital, The Netherlands.
577 consecutive patients during the period 1994-5, and 343 who presented during the period 1996-7.
The variables that seemed to be predictive of acute appendicitis were abstracted from the earlier group. a logistic regression analysis applied, and score created. The score was validated on the 343 patients who presented during 1996-7, and then the groups were combined for further analysis.
Reproducibility of the scoring system obtained by comparing odds ratios (OR) of the two groups; its effectiveness judged by comparing the delayed and normal appendicectomy rates.
The following variables were significantly correlated with the presence of acute appendicitis: white cell count 10 x 10(9)/L or more (score 3), rebound tenderness and male sex (score 2 each); and symptoms present for < 48 hrs and temperature 38 degrees C or more (score 1 each). The OR for the two groups were 1.80 and 1.76, respectively, indicating that score was reproducible. With a sensitivity of 93% and a specificity of 83% it would be at least as accurate as clinical judgment. The normal appendicectomy rate would be 7% instead of 9%. and the negative exploration rates (laparoscopy and primary appendicectomy) would both be 22%. The score would also result in a lower perforation rate (2% compared with 17%).
The score can indicate when there is an indication for laparoscopy in patients with suspected appendicitis.
开发一种可重复的评分系统，以识别阑尾炎诊断存疑且能从诊断性腹腔镜检查中获益的患者。
前瞻性观察性研究。
荷兰的地区教学医院。
1994年至1995年期间连续纳入的577例患者，以及1996年至1997年期间就诊的343例患者。
从早期组中提取似乎可预测急性阑尾炎的变量，进行逻辑回归分析并创建评分。该评分在1996年至1997年期间就诊的343例患者中进行验证，然后将两组合并进行进一步分析。
通过比较两组的比值比（OR）获得评分系统的可重复性；通过比较延迟阑尾切除术和正常阑尾切除术的发生率来判断其有效性。
以下变量与急性阑尾炎的存在显著相关：白细胞计数10×10⁹/L及以上（得3分）、反跳痛和男性（各得2分）；症状出现时间<48小时和体温38℃及以上（各得1分）。两组的OR分别为1.80和1.76，表明评分具有可重复性。其灵敏度为93%，特异度为83%，至少与临床判断一样准确。正常阑尾切除术的发生率将从9%降至7%，阴性探查率（腹腔镜检查和初次阑尾切除术）均为22%。该评分还将导致穿孔率降低（从17%降至2%）。
该评分可表明疑似阑尾炎患者何时有进行腹腔镜检查的指征。
