对疑似急性阑尾炎患者使用急诊科计算机断层扫描的前瞻性评估。

A prospective evaluation of the use of emergency department computed tomography for suspected acute appendicitis.

作者信息

Maluccio M A, Covey A M, Weyant M J, Eachempati S R, Hydo L J, Barie P S

机构信息

Department of Surgery, Weill Medical College of Cornell University, New York, New York, USA.

出版信息

Surg Infect (Larchmt). 2001 Fall;2(3):205-11; discussion 211-4. doi: 10.1089/109629601317202687.

DOI:10.1089/109629601317202687

PMID:12593710

Abstract

BACKGROUND

Computed tomography (CT) is used increasingly to evaluate suspected cases of acute appendicitis (AA) in the emergency department (ED). This prospective study was performed to test the hypothesis that the evaluation of AA by CT in the ED remains suboptimal and that erroneous interpretation diminishes its utility.

METHODS

Consecutive patients 18 years of age or older were enrolled prospectively if AA was among the first three differential diagnoses listed in the record of patients undergoing evaluation of abdominal pain in the ED. Imaging of the abdomen and pelvis was obtained at the discretion of the ED staff or consultant surgeon. Initial CT interpretation was by a radiology resident or fellow along with the surgical staff, but final review by an attending radiologist occurred later. Age, gender, presenting symptoms, white blood cell (WBC) count, final CT results, and final pathology (for patients undergoing operation) were recorded. X +/- SEM, p < 0.05 by chi(2), ANOVA, or MANOVA was used for statistical analysis as appropriate.

RESULTS

A CT scan was performed in 104 patients (83% of those meeting entry criteria), 35 of whom were male (mean age, 37 +/- 2 years) and 69 of whom were female (mean age, 39 +/- 3 years). Thirty-five patients had pathologically proved appendicitis, 28 of whom were diagnosed prospectively by CT. There were seven false-negative scans. Sensitivity, specificity, and positive predictive value for the initial CT reading were 80%, 91%, and 82%, respectively. Gender (p < 0.03), WBC count (p < 0.0002), and a positive initial CT reading (p < 0.0001) correlated with operative management. However, although final CT interpretation did correlate with pathologic confirmation of AA (p < 0.0001), initial CT interpretation did not correlate with the presence of AA (p = 0.52).

CONCLUSION

The ability of CT to predict AA is dependent on the interpretative skill of the individual interpreting the images. Widespread use of CT in the evaluation of patients for AA should be implemented with caution until institution-specific protocols are validated.

摘要

背景

在急诊科（ED），计算机断层扫描（CT）越来越多地用于评估疑似急性阑尾炎（AA）病例。本前瞻性研究旨在验证以下假设：在急诊科通过CT评估AA的效果仍不理想，且错误解读会降低其效用。

方法

如果AA是急诊科腹痛评估患者记录中列出的前三种鉴别诊断之一，则前瞻性纳入连续的18岁及以上患者。腹部和骨盆的影像学检查由急诊科工作人员或会诊外科医生酌情进行。最初的CT解读由放射科住院医师或进修医师以及外科工作人员进行，但随后由放射科主治医师进行最终审核。记录年龄、性别、症状表现、白细胞（WBC）计数、最终CT结果以及最终病理结果（接受手术的患者）。根据情况，采用X +/- SEM、卡方检验、方差分析或多变量方差分析（MANOVA）进行p < 0.05的统计学分析。

结果

104例患者（符合入选标准患者的83%）接受了CT扫描，其中35例为男性（平均年龄37 +/- 2岁），69例为女性（平均年龄39 +/- 3岁）。35例患者经病理证实为阑尾炎，其中28例通过CT前瞻性诊断。有7次扫描结果为假阴性。初始CT解读的敏感性、特异性和阳性预测值分别为80%、91%和82%。性别（p < 0.03）、WBC计数（p < 0.0002）以及初始CT解读阳性（p < 0.0001）与手术治疗相关。然而，尽管最终CT解读与AA的病理证实相关（p < 0.0001），但初始CT解读与AA的存在无关（p = 0.52）。