Naoum Joseph J, Mileski William J, Daller John A, Gomez Guillermo A, Gore Dennis C, Kimbrough Thomas D, Ko Tien C, Sanford Arthur P, Wolf Steven E
Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston 77555-1172, USA.
Am J Surg. 2002 Dec;184(6):587-9; discussion 589-90. doi: 10.1016/s0002-9610(02)01086-3.
Despite considerable experience the reported frequency of misdiagnosis in patients undergoing appendectomy continues in the range of 20% to 40% in some populations.
We developed a clinical guideline that recommended abdominal computed tomography (CT) for all nonpregnant adults in whom the diagnosis of appendicitis was suspected unless the diagnosis could be ruled out clinically. The records of adult patients that underwent appendectomy from July 1998 through October 2001 were reviewed. The clinical guideline was developed in July 2000.
There were 194 appendectomies performed, 114 prior to the guideline and 80 after the development of the guideline. The rate of misdiagnosis decreased from 25% to 6% (P <0.05), the rate of CT use increased from 32% to 84% (P <0.05), and the perforation rate remained unchanged.
These results support the effectiveness of a clinical guideline that encourage the use of abdominal CT in decreasing the frequency of misdiagnosis in cases of suspected appendicitis.
尽管有丰富的经验，但在某些人群中，接受阑尾切除术患者的误诊率仍在20%至40%之间。
我们制定了一项临床指南，建议对所有疑似阑尾炎的非妊娠成年患者进行腹部计算机断层扫描（CT），除非临床可排除诊断。回顾了1998年7月至2001年10月接受阑尾切除术的成年患者的记录。该临床指南于2000年7月制定。
共进行了194例阑尾切除术，其中114例在指南发布前，80例在指南发布后。误诊率从25%降至6%（P<0.05），CT使用率从32%增至84%（P<0.05），穿孔率保持不变。
这些结果支持了一项鼓励使用腹部CT以降低疑似阑尾炎病例误诊率的临床指南的有效性。
