Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
Acad Emerg Med. 2009 Sep;16(9):835-42. doi: 10.1111/j.1553-2712.2009.00486.x. Epub 2009 Aug 18.
The objective was to evaluate the diagnostic accuracy of clinical features and laboratory test results in detecting acute appendicitis.
Clinical features and laboratory test results were prospectively recorded in a consecutive series of 1,101 patients presenting with abdominal pain at the emergency department (ED) in six hospitals. Likelihood ratios (LRs) and the areas under the receiver operating characteristic curve (AUC) were calculated for the individual features. Variants of clinical presentation, based on different combinations of clinical features, were investigated and the accuracies of combinations of clinical features were evaluated.
The discriminative power (AUC) of the individual features in patients with suspected appendicitis ranged from 0.50 to 0.65. For five of the 23 predictor sets, the accuracy for appendicitis was more than 85%. This accuracy was only found in male patients. The relative frequency of these predictor sets ranged from 2% to 13% of patients with suspected appendicitis. A combination of the clinical features migration of pain to the right lower quadrant (RLQ), and direct tenderness in the RLQ, was present in only 28% (120/422) of clinically suspected patients, of whom no more than 85 patients had appendicitis (71%). A "classical" presentation (combination of migration of pain to the RLQ, tenderness in the RLQ, and rigidity) occurred in only 6% (25/422) of patients with suspected appendicitis and yielded an accuracy of 100% in males but only 46% in females.
The discriminative power (AUC) of individual clinical features and laboratory test results for appendicitis was weak in patients with suspected appendicitis. Combinations of clinical features and laboratory tests with high diagnostic accuracy are relatively infrequent in patients with suspected appendicitis.
评估临床特征和实验室检查结果在诊断急性阑尾炎中的准确性。
在六家医院的急诊科连续收治的 1101 例腹痛患者中，前瞻性地记录了临床特征和实验室检查结果。计算了各个特征的似然比（LR）和受试者工作特征曲线下的面积（AUC）。研究了基于不同临床特征组合的不同临床表现变体，并评估了临床特征组合的准确性。
在疑似阑尾炎患者中，单个特征的鉴别能力（AUC）范围为 0.50 至 0.65。在 23 个预测因子组中的 5 个中，阑尾炎的准确率超过 85%。这种准确性仅在男性患者中发现。这些预测因子组的相对频率在疑似阑尾炎患者中范围为 2%至 13%。疼痛向右下象限（RLQ）转移和 RLQ 直接压痛的临床特征组合仅在 422 例疑似临床患者中的 28%（120/422）中出现，其中不超过 85 例患者患有阑尾炎（71%）。“经典”表现（疼痛向 RLQ 转移、RLQ 压痛和强直的组合）仅在疑似阑尾炎患者中的 6%（25/422）中发生，其在男性中的准确率为 100%，但在女性中仅为 46%。
在疑似阑尾炎患者中，单个临床特征和实验室检查结果对阑尾炎的鉴别能力（AUC）较弱。在疑似阑尾炎患者中，具有较高诊断准确性的临床特征和实验室检查组合相对较少。
