Mutgi A, Williams J W, Nettleman M
Department of Medicine, Medical College of Ohio, Toledo 43699.
Arch Intern Med. 1991 Aug;151(8):1589-92. doi: 10.1001/archinte.151.8.1589.
We conducted a retrospective cohort study of 85 consecutive symptomatic patients to evaluate the sensitivity, specificity, and predictive value of plain abdominal roentgenography (PAR) compared with clinical evaluation alone in diagnosis and treatment of renal colic. With a positive intravenous pyelogram and/or actual stone retrieval used as the gold standard, 72 patients had documented stones. The calculated sensitivity and specificity for PAR were 58% (95% confidence interval, 47% to 69%) and 69% (95% confidence interval, 44% to 94%), respectively. In this population with a stone prevalence of 85%, the positive predictive value of PAR was 91%. A clinical scoring system based on signs and symptoms fared as well as PAR (sensitivity, 73%; specificity, 46%; and positive predictive value, 88%). The strategy of clinical scoring followed by selective use of intravenous pyelography was more cost-effective than strategies using PAR. We conclude that the PAR has low sensitivity and specificity and improves the predictive value only marginally, and its routine use is not cost-effective.
我们对85例连续出现症状的患者进行了一项回顾性队列研究，以评估腹部平片（PAR）相较于单纯临床评估在肾绞痛诊断和治疗中的敏感性、特异性及预测价值。以静脉肾盂造影阳性和/或实际取出结石作为金标准，72例患者被证实有结石。PAR的计算敏感性和特异性分别为58%（95%置信区间，47%至69%）和69%（95%置信区间，44%至94%）。在这个结石患病率为85%的人群中，PAR的阳性预测值为91%。基于体征和症状的临床评分系统与PAR的效果相当（敏感性73%；特异性46%；阳性预测值88%）。先进行临床评分然后选择性使用静脉肾盂造影的策略比使用PAR的策略更具成本效益。我们得出结论，PAR的敏感性和特异性较低，仅略微提高预测价值，其常规使用不具有成本效益。
