Kostić Ana, Slavković Andjelka, Marjanović Zoran, Madić Jelica, Krstić Marijana, Zivanović Dragoljub, Djerić Danijela
Klinicki centar Nis, Klinika za decju hirurgiju i ortopediju, Nis, Srbija.
Vojnosanit Pregl. 2010 Aug;67(8):644-8. doi: 10.2298/vsp1008644k.
BACKGROUND/AIMS: Acute appendicitis (AA) remains a diagnostic challenge in children, despite ongoing researches. With an aim to facilitate making diagnosis of AA many scoring systems have been created; among them Alvarado score is the most popular. C-reactive protein (CRP) has proven significance for diagnosing AA in adults, but not in children. The aim of this study was to evaluate significance of Alvarado score, as well as CRP values, in making diagnosis of AA in children.
This prospective six-month study was performed on 257 patients under the age of 15, admitted for acute abdominal pain in the Clinic of Pediatric Surgery and Orthopedics in the Clinical Centre of Nis. Alvarado score and CRP values were determined on admission and compared with final diagnosis on discharge. The patients were divided into two groups: group I--non operated patients with abdominal pain (n=184) and group II--operated on patients for appendectomy (n=73).
Values of Alvardo score were statistically significantly different between groups (group I: 4.9 +/- 1.21, group II: 8.55 +/- 1.32). Also, our results showed significantly high values of CRP measured in operated children (group I: 8.17 +/- 4.7 mg/L, group II: 38 +/- 26 mg/L). Values of validity parameters for Alvarado score were: sensitivity 90%, specifity 80%, positive predictive values 87%; for CRP 95%, 70% and 80%, respectively.
Alvarado score and CRP are very useful adjuvant diagnostic tool for AA to a less experienced surgeon. High values of Alvarado score and CRP cannot be ignored neither at the same time, used as the sole diagnostic method for discriminating children with AA.
背景/目的：尽管研究不断，但儿童急性阑尾炎（AA）的诊断仍是一项挑战。为便于AA的诊断，已创建了许多评分系统；其中阿尔瓦拉多评分最为常用。C反应蛋白（CRP）在成人AA诊断中已证实具有重要意义，但在儿童中并非如此。本研究旨在评估阿尔瓦拉多评分以及CRP值在儿童AA诊断中的意义。
本前瞻性为期六个月的研究对257名15岁以下因急性腹痛入住尼什临床中心小儿外科和矫形外科诊所的患者进行。入院时测定阿尔瓦拉多评分和CRP值，并与出院时的最终诊断进行比较。患者分为两组：第一组——非手术腹痛患者（n = 184）和第二组——接受阑尾切除术的手术患者（n = 73）。
两组间阿尔瓦拉多评分值存在统计学显著差异（第一组：4.9 ± 1.21，第二组：8.55 ± 1.32）。此外，我们的结果显示手术儿童的CRP值显著升高（第一组：8.17 ± 4.7 mg/L，第二组：38 ± 26 mg/L）。阿尔瓦拉多评分的有效性参数值为：敏感性90%，特异性80%，阳性预测值87%；CRP的分别为95%、70%和80%。
阿尔瓦拉多评分和CRP对经验不足的外科医生而言是诊断AA非常有用的辅助工具。阿尔瓦拉多评分和CRP值升高均不能忽视，但不能同时将其作为鉴别儿童AA的唯一诊断方法。
