Perez Jose, Barone James E, Wilbanks Tyr O, Jorgensson Dana, Corvo Philip R
Department of Surgery, The Stamford Hospital/Columbia University College of Physicians and Surgeons Program in Surgery, 190 W. Broad St., CT 06902, USA.
Am J Surg. 2003 Mar;185(3):194-7. doi: 10.1016/s0002-9610(02)01364-8.
Based on a study at our hospital in 1994, we established a practice guideline for appendicitis patients. The practice guideline was followed well except for an increased number of preoperative computed tomography (CT) scans.
Data collected from the previous study of 100 patients were compared with data from consecutive patients, 118 total, seen over a similar time period in the year 2000.
The percentage of CT scans ordered for the diagnosis of patients who underwent appendectomy markedly increased from 11% in 1994 to 48.3% in 2000. (P <0.001) The percentage of normal appendixes removed did not change significantly from 12% in 1994 to 17.8% in 2000 (P = 0.317). Patients who had a CT scan were no less likely to have a normal appendix at surgery (P = 0.386) and a significant increase in preoperative Emergency Department length of stay (P <0.001). CT was accurate 80% of the time in 2000 and 81% of the time in 1994. Only 14 of 57 CT scans were ordered by surgeons.
The use of preoperative abdominal CT scanning has not improved the accuracy of the diagnosis of appendicitis at our institution. It has resulted in a significant increase in Emergency Department preoperative length of stay and the finding of a normal appendix at surgery. As nonsurgeons ordered the majority of preoperative CT scans, earlier input by surgeons might increase the rate of accurate clinical diagnosis and decrease the number of CT scans ordered.
基于我院1994年的一项研究，我们制定了阑尾炎患者的诊疗指南。除术前计算机断层扫描（CT）检查数量增加外，该诊疗指南得到了很好的遵循。
将之前对100例患者的研究收集的数据与2000年同期连续收治的118例患者的数据进行比较。
为行阑尾切除术患者进行诊断而安排的CT扫描比例从1994年的11%显著增加至2000年的48.3%。（P<0.001）切除的正常阑尾比例从1994年的12%至2000年的17.8%无显著变化（P = 0.317）。接受CT扫描的患者手术时阑尾正常的可能性并无降低（P = 0.386），且术前急诊科住院时间显著增加（P<0.001）。2000年CT检查的准确率为80%，1994年为81%。57例CT扫描中只有14例是由外科医生安排的。
在我们机构，术前腹部CT扫描的使用并未提高阑尾炎诊断的准确性。它导致了急诊科术前住院时间显著增加以及手术中发现正常阑尾。由于大多数术前CT扫描是由非外科医生安排的，外科医生更早介入可能会提高准确临床诊断率并减少CT扫描的安排数量。
