疑似阑尾炎患儿的阑尾炎评分。一项随机临床试验。
Appendicitis score for children with suspected appendicitis. A randomized clinical trial.
机构信息
Department of Pediatric Surgery, Kuopio University Hospital, Kuopio, Finland.
出版信息
Langenbecks Arch Surg. 2009 Nov;394(6):999-1004. doi: 10.1007/s00423-008-0425-0. Epub 2008 Oct 8.
BACKGROUND/PURPOSE: Appendicectomy is often performed without certainty of diagnosis. We have previously constructed and validated a diagnostic score for acute appendicitis in children. The purpose of this prospective study was to determine whether diagnosis by using the appendicitis score may improve clinical outcomes for children with suspected appendicitis.
METHODS
A total of 126 children with suspected appendicitis were randomly assigned to either the appendicitis-score group or the no-score group. The attending general surgeon indicated a provisional diagnosis, a differential diagnosis and a provisional disposition on admission at 3 h and, if necessary, at 6, 9 and 12 h. The decision to operate was based on a clinical assessment in the no-score group and on the use of the diagnostic scoring system in the appendicitis-score group. The main outcome measures were the diagnostic accuracy (primary endpoint), the rate of unnecessary appendicectomies and adverse events between the two groups.
RESULTS
The diagnostic accuracy was significantly greater in the appendicitis-score group compared with that in the no-score group (92% vs 80%; P = 0.04). A significantly higher rate of unnecessary appendicectomies was observed in the no-score group compared with that in the appendicitis-score group (29% vs 17%; P = 0.05). In the appendicitis-score group, the sensitivity was 100%, specificity was 88%, positive predictive value was 83% and negative predictive value was 100%, compared to sensitivity of 96%, specificity of 67%, positive predictive value of 70% and negative predictive value of 96% observed in the no-score group. There were no differences in terms of the length of hospital stay, rate of complications and appendiceal histology between the two groups. The only case with missed appendicitis was in the no-score group.
CONCLUSION
The use of the appendicitis score can reduce the unnecessary appendicectomy rate in general surgeons treating children with suspected appendicitis.
背景/目的：阑尾切除术通常在无法确定诊断的情况下进行。我们之前构建并验证了儿童急性阑尾炎的诊断评分。本前瞻性研究的目的是确定使用阑尾炎评分是否可以改善疑似阑尾炎患儿的临床结局。
方法
共有 126 名疑似阑尾炎的患儿被随机分配到阑尾炎评分组或无评分组。主治普外科医生在入院 3 小时、必要时在 6、9 和 12 小时分别对临时诊断、鉴别诊断和临时处置进行指示。无评分组的手术决策基于临床评估，而阑尾炎评分组则基于诊断评分系统的使用。主要观察指标是两组之间的诊断准确性（主要终点）、不必要的阑尾切除术率和不良事件发生率。
结果
阑尾炎评分组的诊断准确性明显高于无评分组（92% vs 80%；P = 0.04）。无评分组的不必要阑尾切除术率明显高于阑尾炎评分组（29% vs 17%；P = 0.05）。在阑尾炎评分组中，敏感性为 100%，特异性为 88%，阳性预测值为 83%，阴性预测值为 100%，而无评分组的敏感性为 96%，特异性为 67%，阳性预测值为 70%，阴性预测值为 96%。两组的住院时间、并发症发生率和阑尾组织学无差异。唯一漏诊的阑尾炎病例发生在无评分组。
结论
在主治普外科医生治疗疑似阑尾炎患儿时，使用阑尾炎评分可以降低不必要的阑尾切除术率。
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