Center for Evidence Based Imaging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Radiology. 2010 Aug;256(2):460-5. doi: 10.1148/radiol.10091570. Epub 2010 Jun 7.
To estimate the correlation between the negative appendectomy rate (NAR) and the rate of preoperative computed tomography (CT) in patients suspected of having acute appendicitis who presented to the emergency department during an 18-year period.
This retrospective institutional review board-approved, HIPAA-compliant study was performed in a 719-bed tertiary care adult teaching hospital with 58,000 annual emergency department visits. The authors obtained a waiver of informed consent and used the medical records system to compare patients suspected of having appendicitis who presented to the emergency department between 2003 and 2007 to those who presented between 1990 and 1994, the period just before CT became commonly used at the authors' institution for the evaluation of appendicitis. Surgical and pathology reports were reviewed to determine the NAR, and the authors queried the radiology databases to determine the proportion of appendectomy patients who underwent preoperative imaging. Outcome measures included the NAR, the proportion of appendectomy patients who underwent preoperative CT, and the annual number of appendectomies performed. The chi(2) test for trend was used to assess for changes in proportions, and linear regression was used to evaluate numeric trends.
From 1990 to 2007, the NAR decreased significantly from 23.0% to 1.7% (P < .0001), the annual number of appendectomies decreased significantly from 217 per year to 119 per year (P = .0003), and the proportion of patients undergoing appendectomy who underwent preoperative CT increased significantly from 1% to 97.5% (P < .0001).
There was a significant reduction in both the NAR and the number of appendectomies in patients who presented to the emergency department during an 18-year period, which was associated with a significant increase in the use of preoperative abdominal CT.
评估在 18 年期间因疑似急性阑尾炎而就诊于急诊科的患者中，阴性阑尾切除率（NAR）与术前计算机断层扫描（CT）率之间的相关性。
本回顾性机构审查委员会批准的 HIPAA 合规研究在一家拥有 719 张床位的三级保健成人教学医院中进行，该医院每年有 58000 例急诊就诊。作者获得了知情同意豁免，并使用病历系统将 2003 年至 2007 年期间因疑似阑尾炎而就诊于急诊科的患者与 CT 开始在作者所在机构广泛用于评估阑尾炎之前的 1990 年至 1994 年期间就诊的患者进行比较。手术和病理报告进行审查以确定 NAR，作者查询放射科数据库以确定接受术前影像学检查的阑尾切除术患者的比例。主要结局指标包括 NAR、接受术前 CT 的阑尾切除术患者的比例以及每年进行的阑尾切除术数量。使用趋势卡方检验评估比例的变化，使用线性回归评估数值趋势。
从 1990 年至 2007 年，NAR 从 23.0%显著下降至 1.7%（P<0.0001），每年的阑尾切除术数量从 217 例显著下降至 119 例（P=0.0003），接受阑尾切除术的患者中接受术前 CT 的比例从 1%显著上升至 97.5%（P<0.0001）。
在 18 年期间因疑似急性阑尾炎而就诊于急诊科的患者中，NAR 和阑尾切除术数量均显著下降，这与术前腹部 CT 使用的显著增加有关。
