Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
Dig Liver Dis. 2014 Feb;46(2):119-24. doi: 10.1016/j.dld.2013.09.017. Epub 2013 Nov 16.
External validation and comparison of the diagnostic accuracy of two predictive tools, the emergency department triad and the clinical scoring tool in diagnosing acute diverticulitis.
Two derivation datasets were used crosswise for external validation. In addition, both tools were validated in a third independent cohort. Predictive values were reassessed and the Area Under the Curve expressed discriminatory capacity. Performance was compared by calculating positive predictive values of the emergency department triad in the validation cohorts and with a cut-off analysis for the clinical scoring tool at a positive predictive value of 90%.
Predictive value of the emergency department triad was comparable to the clinical scoring tool. The positive predictive value of the emergency department triad (97%) decreased in the clinical scoring tool cohort (81%) and was excellent in the independent cohort (100%), identifying 24%, 20% and 14% of the patients. A smaller proportion of patients with diverticulitis could be identified with the clinical scoring tool (6%, 19% and 9%).
The emergency department triad as well as the clinical scoring tool have significant predictive value in external cohorts of patients suspected of diverticulitis. These tools can be used to select patients in whom additional imaging to diagnose acute diverticulitis may be omitted.
验证和比较两种预测工具，即急诊三联征和临床评分工具，在诊断急性憩室炎方面的诊断准确性。
使用两个交叉的原始数据集进行外部验证。此外，还在第三个独立队列中验证了这两种工具。重新评估预测值并表示曲线下面积以表示区分能力。通过计算验证队列中急诊三联征的阳性预测值，并通过对临床评分工具的截断分析（阳性预测值为 90%），比较工具的性能。
急诊三联征的预测值与临床评分工具相当。急诊三联征的阳性预测值（97%）在临床评分工具队列中降低（81%），在独立队列中表现出色（100%），可识别出 24%、20%和 14%的患者。使用临床评分工具可识别出的憩室炎患者比例较小（6%、19%和 9%）。
急诊三联征和临床评分工具在怀疑患有憩室炎的患者的外部队列中具有显著的预测价值。这些工具可用于选择可能可以省略额外的影像学检查来诊断急性憩室炎的患者。
