Lloyd S, Sharma A
Can Fam Physician. 1989 Feb;35:235-9.
We report a case of acute appendicitis in a 36-year-old patient with recurrent abdominal pain diagnosed seven years previously as abdominal epilepsy. Prior to his reported presentation, he successfully managed his pain at home by self-administration of phenobarbital, but on three previous occasions the patient required emergency-department treatment for severe pain. Our patient had been symptom free for several months prior to this presentation. This case raises several important questions regarding the approach to the diagnosis of acute appendicitis in the emergency department. The case illustrates the relative value of clinical and paraclinical data in establishing the diagnosis. We evaluate accepted clinical and paraclinical data used to diagnose acute appendicitis and advocate using likelihood ratios to increase diagnostic accuracy.
我们报告了一例36岁的急性阑尾炎患者，该患者有反复腹痛症状，七年前被诊断为腹型癫痫。在其此次就诊之前，他通过自行服用苯巴比妥在家中成功控制了疼痛，但此前有三次患者因剧痛而需要到急诊科治疗。在此次就诊前的几个月里，我们的患者一直没有症状。该病例引发了关于急诊科急性阑尾炎诊断方法的几个重要问题。该病例说明了临床和辅助临床数据在确立诊断中的相对价值。我们评估了用于诊断急性阑尾炎的公认临床和辅助临床数据，并主张使用似然比来提高诊断准确性。
