Park Jong Seob, Jeong Jin Ho, Lee Jong In, Lee Jong Hoon, Park Jea Kun, Moon Hyoun Jong
Department of Surgery, Myongji Hospital, Kwandong University, Goyang, Korea.
Am Surg. 2013 Jan;79(1):101-6.
The objectives were to evaluate the effectiveness of ultrasonography, computed tomography, and physical examination for diagnosing acute appendicitis with analyzing their accuracies and negative appendectomy rates in a clinical rather than research setting. A total of 2763 subjects were enrolled. Sensitivity, specificity, positive predictive value, and negative predictive value and negative appendectomy rate for ultrasonography, computed tomography, and physical examination were calculated. Confirmed positive acute appendicitis was defined based on pathologic findings, and confirmed negative acute appendicitis was defined by pathologic findings as well as on clinical follow-up. Sensitivity, specificity, positive predictive value, and negative predictive value for ultrasonography were 99.1, 91.7, 96.5, and 97.7 per cent, respectively; for computed tomography, 96.4, 95.4, 95.6, and 96.3 per cent, respectively; and for physical examination, 99.0, 76.1, 88.1, and 97.6 per cent, respectively. The negative appendectomy rate was 5.8 per cent (5.2% in the ultrasonography group, 4.3% in the computed tomography group, and 12.2% in the physical examination group). Ultrasonography/computed tomography should be performed routinely for diagnosis of acute appendicitis. However, in view of its advantages, ultrasonography should be performed first. Also, if the result of a physical examination is negative, imaging studies after physical examination can be unnecessary.
目的是在临床而非研究环境中，通过分析超声检查、计算机断层扫描和体格检查诊断急性阑尾炎的准确性及阴性阑尾切除率，来评估它们的有效性。共纳入2763名受试者。计算了超声检查、计算机断层扫描和体格检查的敏感性、特异性、阳性预测值、阴性预测值及阴性阑尾切除率。确诊的阳性急性阑尾炎基于病理结果定义，确诊的阴性急性阑尾炎则由病理结果以及临床随访定义。超声检查的敏感性、特异性、阳性预测值和阴性预测值分别为99.1%、91.7%、96.5%和97.7%；计算机断层扫描分别为96.4%、95.4%、95.6%和96.3%；体格检查分别为99.0%、76.1%、88.1%和97.6%。阴性阑尾切除率为5.8%（超声检查组为5.2%，计算机断层扫描组为4.3%，体格检查组为12.2%）。应常规进行超声检查/计算机断层扫描以诊断急性阑尾炎。然而，鉴于其优势，应首先进行超声检查。此外，如果体格检查结果为阴性，则体格检查后可能无需进行影像学检查。
