对哈科特港大学教学医院（位于哈科特港）使用本盖齐和法鲁吉改良阿尔瓦拉多评分法对急性阑尾炎进行推定准确诊断的前瞻性评估。

Prospective evaluation of the Bengezi and Al-Fallouji modified Alvarado score for presumptive accurate diagnosis of acute appendicitis in University of Port Harcourt Teaching Hospital, Port Harcourt.

作者信息

Fente B G, Echem R C

机构信息

Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

出版信息

Niger J Med. 2009 Oct-Dec;18(4):398-401. doi: 10.4314/njm.v18i4.51251.

DOI:10.4314/njm.v18i4.51251

PMID:20120145

Abstract

BACKGROUND

The accurate diagnosis of acute appendicitis (AP) in a patient is valuable to the busy clinician. Decision making in cases of AP poses a clinical challenge especially in developing countries where advanced radiological investigations are not readily available and do not appear cost effective, clinical parameters remain the mainstay of diagnosis. Time and resources wasted on surgical intervention, with the added risks of surgery and anaesthesia, only to discover that this was unnecessary remains a big challenge. This prospective study was carried out to assess the accuracy of the Bengezi and Al-Fallouji modified Alvarado score in presumptive diagnosis of AP and its effect on the negative appendicectomy rate (NAR) at the University of Port Harcourt Teaching Hospital.

METHODS

A retrospective study of the NAR of this hospital between June 2000 and May 2002 was carried out. All consecutive patients (128) who presented with presumptive diagnosis of AP between June 2003 and May 2004 were scored using the Bengezi and Al-Fallouji modified Alvarado scoring system and correlated with histological diagnosis. Patients discharged without surgery based on score, were reviewed in the outpatient's clinic for one month to ascertain that they did not need surgical intervention. The NAR for all appendicectomies performed by surgeons for presumptive diagnosis of AP without scoring between June 2004 and May 2005 was determined as control. Validity of the scoring system was assessed by calculating sensitivity, specificity, positive and negative predictive values.

RESULTS

A total of 128 patients were scored. Forty patients with scores less than 4 after eight hours observations and re-evaluation at the Accident and Emergency were discharged without surgery. Eighty eight patients had appendicectomies as treatment for scores 5-10. There were 39 males and 49 females. In eighty patients, the appendix was histologically inflammed and 8 were normal, giving a NAR of 9.09%. High sensitivity of 92.93% and specificity of 92.93% were recorded in the study. The NAR of the retrospective study was 26.4% and 19.05% for the control group operated without scoring.

CONCLUSION

The Bengezi and Al-Fallouji modified Alvarado score is a simple, safe and cost effective aid in diagnosis of acute appendicitis and decreases NAR.

摘要

背景

准确诊断患者的急性阑尾炎（AP）对忙碌的临床医生而言很有价值。阑尾炎病例的决策构成了一项临床挑战，尤其是在发展中国家，那里先进的放射学检查不易获得且似乎不具有成本效益，临床参数仍是诊断的主要依据。在手术干预上浪费时间和资源，再加上手术和麻醉带来的额外风险，结果却发现手术并无必要，这仍然是一个巨大的挑战。本前瞻性研究旨在评估邦盖齐和法卢吉改良的阿尔瓦拉多评分在疑似阑尾炎诊断中的准确性及其对哈科特港大学教学医院阴性阑尾切除率（NAR）的影响。

方法

对该医院2000年6月至2002年5月期间的阴性阑尾切除率进行回顾性研究。对2003年6月至2004年5月期间所有以疑似阑尾炎诊断就诊的连续患者（128例）使用邦盖齐和法卢吉改良的阿尔瓦拉多评分系统进行评分，并与组织学诊断进行关联。基于评分未接受手术而出院的患者在门诊接受了为期一个月的复查，以确定他们不需要手术干预。将2004年6月至2005年5月期间外科医生对疑似阑尾炎未进行评分而进行的所有阑尾切除术的阴性阑尾切除率确定为对照。通过计算敏感性、特异性、阳性和阴性预测值来评估评分系统的有效性。

结果

共对128例患者进行了评分。在急症室经过8小时观察和重新评估后，40例评分低于4分的患者未接受手术而出院。88例评分在5 - 10分的患者接受了阑尾切除术作为治疗。其中男性39例，女性49例。80例患者的阑尾组织学上有炎症，8例正常，阴性阑尾切除率为9.09%。研究中记录到高敏感性为92.93%，特异性为92.93%。回顾性研究的阴性阑尾切除率，未评分进行手术的对照组为26.4%，另一对照组为19.05%。