Izbicki J R, Knoefel W T, Wilker D K, Mandelkow H K, Müller K, Siebeck M, Schweiberer L
Department of Surgery (Klinikum Innenstadt), Ludwig Maximilians Universität, Munich, Federal Republic of Germany.
Eur J Surg. 1992 Apr;158(4):227-31.
To formulate a score system that would make the preoperative diagnosis of acute appendicitis more accurate.
Retrospective then prospective study.
City University Hospital.
536 patients who had their appendixes removed between 1981 and 1986 (retrospective study), and 150 consecutive patients admitted with a presumptive diagnosis of appendicitis between 1987 and 1988 (prospective study).
Correlation between the histological diagnosis of appendicitis and variables representing history, clinical examination, and laboratory investigations.
The rate of histologically proven negative appendicectomies in the retrospective series was 40% and in the prospective series 33%. The variables that were thought to be predictive were: male sex, white cell count of greater than 11 x 10(9)/l, history of less than 24 hours with no previous complaints, rebound tenderness, shift of pain from the epigastrium, and localised guarding, but all criteria had low specificities and sensitivities when applied prospectively, and combining the scores did not improve them.
The accurate diagnosis of appendicitis depends largely on the experience of the surgeon and is not improved by the application of a score system that includes the above variables.
制定一个能使急性阑尾炎术前诊断更准确的评分系统。
回顾性研究，然后进行前瞻性研究。
城市大学医院。
1981年至1986年间行阑尾切除术的536例患者（回顾性研究），以及1987年至1988年间连续收治的150例疑似阑尾炎患者（前瞻性研究）。
阑尾炎组织学诊断与代表病史、临床检查和实验室检查的变量之间的相关性。
回顾性系列中组织学证实为阴性的阑尾切除术发生率为40%，前瞻性系列中为33%。被认为具有预测性的变量有：男性、白细胞计数大于11×10⁹/L、病程小于24小时且既往无类似症状、反跳痛、疼痛从上腹部转移、局部肌紧张，但前瞻性应用时所有标准的特异性和敏感性都较低，综合评分也未改善这些情况。
阑尾炎的准确诊断很大程度上取决于外科医生的经验，应用包含上述变量的评分系统并不能提高诊断准确性。
