Sitter H, Hoffmann S, Hassan I, Zielke A
Institute of Theoretical Surgery, Philipps University of Marburg, Baldingerstrasse, 35033 Marburg, Germany.
Langenbecks Arch Surg. 2004 Jun;389(3):213-8. doi: 10.1007/s00423-003-0436-9. Epub 2003 Nov 18.
At times, the diagnosis of acute appendicitis may be difficult. However, for minimum morbidity to be obtained, early and accurate diagnosis is essential. This study aimed to validate a scoring system proposed by Eskelinen et al. as an aid in making the diagnosis of appendicitis.
The prospectively documented data of a consecutive series of 2,359 patients admitted for suspicion of appendicitis were used for validation. Accuracy and positive predictive value were defined as the main overall performance parameters, as was the rate of unnecessary operations to assess changes of patient management. Overall performance was assessed by receiver-operator characteristics (ROC) analysis.
Of 2,359 patients, 662 were proven to have acute appendicitis (prevalence of 28%). The overall sensitivity, specificity, positive and negative predictive value, and accuracy of the score were 0.79, 0.85, 0.68, 0.91 and 0.835 at a cut-off value of 55. Calibration of the score's cut-off value to 57 yielded more favourable results (0.72, 0.91, 0.76, 0.9 and 0.86), and the rate of unnecessary operations declined from 26.6% to 15.4% ( P<0.05, chi2). ROC analysis revealed an area index of 0.91.
The Eskelinen score delivered acceptable clinical results only after calibration to a cut-off value of 57. The data from this study suggest the investigation of whether a calibrated score might be particularly instrumental in the pre-admission evaluation of the patient in whom appendicitis is suspected.
有时，急性阑尾炎的诊断可能存在困难。然而，为了将发病率降至最低，早期准确诊断至关重要。本研究旨在验证Eskelinen等人提出的一种评分系统，以辅助阑尾炎的诊断。
前瞻性记录的连续2359例因疑似阑尾炎入院患者的数据用于验证。准确性和阳性预测值被定义为主要的总体性能参数，不必要手术率用于评估患者管理的变化。通过受试者操作特征（ROC）分析评估总体性能。
2359例患者中，662例被证实患有急性阑尾炎（患病率为28%）。在临界值为55时，该评分的总体敏感性、特异性、阳性和阴性预测值以及准确性分别为0.79、0.85、0.68、0.91和0.835。将评分的临界值校准为57产生了更有利的结果（0.72、0.91、0.76、0.9和0.86），不必要手术率从26.6%降至15.4%（P<0.05，卡方检验）。ROC分析显示面积指数为0.91。
Eskelinen评分仅在校准至临界值57后才产生可接受的临床结果。本研究数据表明，对于疑似阑尾炎患者，校准后的评分在入院前评估中是否特别有用值得研究。
