Tepel Juergen, Sommerfeld Annette, Klomp Hans-Juergen, Kapischke Matthias, Eggert Albrecht, Kremer Bernd
Department of General Surgery and Thoracic Surgery, University-Hospital of Schleswig-Holstein, Campus Kiel, Arnold Heller Strasse 7, 24105 Kiel, Germany.
Langenbecks Arch Surg. 2004 Jun;389(3):219-24. doi: 10.1007/s00423-003-0439-6. Epub 2003 Nov 22.
The aim of this prospective study was to evaluate different diagnostic modalities routinely employed in a district hospital.
Four hundred subsequent patients presenting with acute abdominal pain were included over a period of 18 months. Patient characteristics, diagnostic work-up, intraoperative findings, histology and clinical outcome were documented. Rectal temperature, white cell count (WCC), C-reactive protein (CRP), ultrasonography (US) and Ohmann score were analysed with relation to diagnostic value.
Negative appendicectomy rate and negative laparotomy rate on the day of admission were 22% and 21%, respectively. Sensitivity was highest for WCC and CRP (0.82 and 0.85) but US showed highest values for specificity (0.92), accuracy (0.85) and odds ratio (13.06). No patient with an Ohmann score below 6.5 suffered from acute appendicitis. With regard to different levels of training in US, experienced surgeons and radiologists had best values for specificity (1.00 and 0.98) and accuracy (0.90 and 0.94). Surprisingly, less-experienced sonographers also achieved good results with regard to specificity (up to 0.96) and positive predictive value (up to 0.89).
Diagnostic accuracy of acute appendicitis remains insufficient, with an unacceptable high rate of unnecessary operations. Only the promotion of routine ultrasonography might contribute to an improvement in the near future.
本前瞻性研究的目的是评估一家地区医院常规使用的不同诊断方法。
在18个月的时间里纳入了400例随后出现急性腹痛的患者。记录患者特征、诊断检查、术中发现、组织学和临床结果。分析直肠温度、白细胞计数（WCC）、C反应蛋白（CRP）、超声检查（US）和奥曼评分与诊断价值的关系。
入院当天阴性阑尾切除术率和阴性剖腹术率分别为22%和21%。WCC和CRP的敏感性最高（分别为0.82和0.85），但US在特异性（0.92）、准确性（0.85）和比值比（13.06）方面显示出最高值。奥曼评分低于6.5的患者均未患急性阑尾炎。关于US的不同培训水平，经验丰富的外科医生和放射科医生在特异性（分别为1.00和0.98）和准确性（分别为0.90和0.94）方面具有最佳值。令人惊讶的是，经验较少的超声检查人员在特异性（高达0.96）和阳性预测值（高达0.89）方面也取得了良好的结果。
急性阑尾炎的诊断准确性仍然不足，不必要手术的发生率高得令人无法接受。只有推广常规超声检查可能在不久的将来有助于改善这种情况。
