Apisarnthanarak Piyaporn, Suvannarerg Voraparee, Pattaranutaporn Poompis, Charoensak Aphinya, Raman Steven S, Apisarnthanarak Anucha
Department of Radiology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.
Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Am J Emerg Med. 2015 Feb;33(2):266-70. doi: 10.1016/j.ajem.2014.11.056. Epub 2014 Dec 3.
The objective of the study is to assess the utility of Alvarado score in the diagnosis of acute appendicitis and the utility of computed tomographic (CT) scan for evaluation of acute appendicitis when stratified by Alvarado scores.
Retrospective cohort study comprised adult patients who underwent abdominal CT for suspected acute appendicitis between January 2006 and December 2009. Two abdominal radiologists independently reviewed the CT scans; any discrepancies were resolved by a consensus review. Alvarado scores were calculated and categorized as low (0-3), equivocal (4-6), or high (7-10) probability for appendicitis. The diagnostic utility of CT scans and Alvarado score for acute appendicitis were compared with the criterion standard of combined medical chart review and pathology findings.
In a cohort of 158 subjects, 73 (46.2%) had clinical diagnoses of acute appendicitis. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT scan in the diagnosis of acute appendicitis were 97.5%, 98.6%, 96.5%, 96.0%, and 98.8%, respectively. The mean Alvarado score for subjects with complicated appendicitis was significantly higher (7.95) than subjects with uncomplicated appendicitis (6.67) and those with other diagnoses (5.95). Acute appendicitis was confirmed in 2 (13.3%) of 15 subjects with low probability Alvarado scores, 16 (30.8%) of 52 subjects with equivocal scores, and 55 (60.4%) of 91 subjects with high probability scores.
The CT scan had high diagnostic utility for acute appendicitis. The Alvarado score was not a reliable independent predictive tool for acute appendicitis and could not replace CT scan.
本研究的目的是评估阿尔瓦拉多评分在急性阑尾炎诊断中的效用，以及按阿尔瓦拉多评分分层时计算机断层扫描（CT）对急性阑尾炎评估的效用。
回顾性队列研究纳入了2006年1月至2009年12月期间因疑似急性阑尾炎接受腹部CT检查的成年患者。两名腹部放射科医生独立审查CT扫描结果；任何差异均通过共识审查解决。计算阿尔瓦拉多评分，并将其分为阑尾炎低概率（0 - 3分）、可疑（4 - 6分）或高概率（7 - 10分）。将CT扫描和阿尔瓦拉多评分对急性阑尾炎的诊断效用与综合病历审查和病理结果的标准进行比较。
在158名受试者的队列中，73名（46.2%）有急性阑尾炎的临床诊断。CT扫描诊断急性阑尾炎的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为97.5%、98.6%、96.5%、96.0%和98.8%。复杂性阑尾炎患者的平均阿尔瓦拉多评分（7.95）显著高于非复杂性阑尾炎患者（6.67）和其他诊断患者（5.95）。阿尔瓦拉多评分低概率的15名受试者中有2名（13.3%）确诊为急性阑尾炎，可疑评分的52名受试者中有16名（30.8%），高概率评分的91名受试者中有55名（60.4%）。
CT扫描对急性阑尾炎具有较高的诊断效用。阿尔瓦拉多评分不是急性阑尾炎可靠的独立预测工具，不能替代CT扫描。
