Sanabria Alvaro, Domínguez Luis Carlos, Bermúdez Charles, Serna Adriana
Departamento de Cirugía, Universidad de La Sabana, Cundinamarca, Colombia.
Biomedica. 2007 Sep;27(3):419-28.
Diagnosis of apendicitis is difficult; however several clinical scales have been developed that attempt to improve diagnostic accuracy.
The operational characteristics of Alvarado and Fenyö scales were defined in patients with abdominal pain suggestive of appendicitis and were compare with clinical and pathological diagnoses.
A prospective trial assessed the diagnostic tests. Sign, symptoms, and laboratory tests were included in scales selected. Surgeon decision was maintained independent from the results of the scales. Sensitivity, specificity, positive and negative predictive value and positive and negative likelihood ratio for each scale was compared with the surgeon evaluation.
The sample included 374 patients with approximately equal sexes. Of these 269 patients underwent surgery. Howeve, 16.9% of the male and 31.4% of female patients did not have appendicitis. For men, a diagnosis made by the surgeon had better sensitivity than scales (86.2% vs. 73% for Alvarado and 67.2% for Fenyö) without significant differences in specificity. For women, surgeon and Alvarado scale diagnoses were similar, and better than Fenyö scale (77.1% vs. 79.5% for Alvarado and 47% for Fenyö), but specificity was higher for Fenyö scale (92.9% vs. 71.4% for Alvarado and 75.9% for surgeon). Accuracy in diagnosis of appendicitis increases with a higher Alvarado score.
For men with abdominal pain on right lower quadrant, surgeon diagnosis is more accurate than scales. For women, Fenyö scale offers a better sensitivity. Alvarado score can facilitate decision-making in patients with these abdominal symptoms.
阑尾炎的诊断颇具难度；然而，已开发出多种临床量表，旨在提高诊断准确性。
确定阿尔瓦拉多（Alvarado）量表和费尼奥（Fenyö）量表在疑似阑尾炎腹痛患者中的操作特征，并与临床及病理诊断结果进行比较。
一项前瞻性试验评估了诊断测试。选定的量表纳入了体征、症状及实验室检查结果。外科医生的诊断决策与量表结果保持独立。将各量表的敏感性、特异性、阳性和阴性预测值以及阳性和阴性似然比与外科医生的评估结果进行比较。
样本包括374名性别大致相等的患者。其中269名患者接受了手术。然而，16.9%的男性患者和31.4%的女性患者并无阑尾炎。对于男性患者，外科医生做出的诊断比量表具有更高的敏感性（阿尔瓦拉多量表为86.2%，费尼奥量表为67.2%，与之相比外科医生诊断的敏感性为73%），特异性方面无显著差异。对于女性患者，外科医生和阿尔瓦拉多量表的诊断结果相似，且优于费尼奥量表（阿尔瓦拉多量表为79.5%，费尼奥量表为47%，与之相比外科医生诊断的敏感性为77.1%），但费尼奥量表的特异性更高（阿尔瓦拉多量表为71.4%，外科医生诊断的特异性为75.9%，与之相比费尼奥量表为92.9%）。阿尔瓦拉多评分越高，阑尾炎诊断的准确性越高。
对于右下腹疼痛的男性患者，外科医生的诊断比量表更准确。对于女性患者，费尼奥量表具有更高的敏感性。阿尔瓦拉多评分有助于对有此类腹部症状的患者做出决策。
