Gungor Faruk, Kilic Taylan, Akyol Kamil Can, Ayaz Gizem, Cakir Umut Cengiz, Akcimen Mehmet, Eken Cenker
Department of Emergency Medicine, Antalya Training and Research Hospital, Antalya, Turkey.
Department of Emergency Medicine, Akdeniz University Medical Faculty, Antalya, Turkey.
Acad Emerg Med. 2017 May;24(5):578-586. doi: 10.1111/acem.13169. Epub 2017 Apr 25.
Early and accurate diagnosis of acute appendicitis (AA) with ultrasound (US) can minimize the morbidity and mortality of the patients. In this regard, US can help emergency physicians (EPs) in the diagnosing process and clinical decision making for AA. Therefore, we primarily aimed to evaluate the effectiveness of point-of-care US (POCUS) in clinical decision making of EPs for the diagnostic evaluation for AA in the emergency department (ED).
The study sample consisted of patients aged > 18 years who presented to the ED with abdominal pain and underwent diagnostic evaluation for AA. All patients were examined initially with POCUS by EPs and then with radiology-performed US (RADUS) by radiologists. Pre- and post-POCUS median diagnostic certainty values (MDCVs) for AA were determined with visual analog scale (VAS) scores (0 = not present, 100 = certainly present) by POCUS performers. Definitive diagnoses were determined by surgery, pathologic evaluation of appendectomy specimens, or clinical follow-up results. The sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) for POCUS and RADUS together with pre- and post-POCUS VAS scores for MDCVs were compared.
A total of 264 patients were included into the final analysis and 169 (64%) had a diagnosis of AA. The sensitivity, specificity, PLR, and NLR of US examinations were 92.3% (95% confidence interval [CI] = 87.2%-95.8%), 95.8% (89.5%-98.8%), 21.9 (8.4-57.2), and 0.08 (0.05-0.1) for POCUS and 76.9% (69.8-83%), 97.8% (84.9-99.7%), 36.4 (9.25-144.3), and 0.24 (0.18-0.31) for RADUS, respectively. Pre-POCUS and post-POCUS VAS scores for MDCVs were 60 (interquartile range [IQR] = 50-65) and 95 (IQR = 20-98), respectively (p = 0.000).
Point-of-care ultrasonography, when performed in ED for the diagnosis of AA, has high sensitivity and specificity and had a positive impact on the clinical decision making of EPs.
通过超声（US）对急性阑尾炎（AA）进行早期准确诊断，可将患者的发病率和死亡率降至最低。在这方面，超声有助于急诊医生（EPs）在AA的诊断过程和临床决策中发挥作用。因此，我们的主要目的是评估床旁超声（POCUS）在急诊医生对急诊科（ED）AA诊断评估的临床决策中的有效性。
研究样本包括年龄大于18岁、因腹痛就诊于ED并接受AA诊断评估的患者。所有患者最初由急诊医生进行POCUS检查，然后由放射科医生进行放射学超声（RADUS）检查。POCUS检查者通过视觉模拟量表（VAS）评分（0 = 不存在，100 = 肯定存在）确定AA的POCUS前后中位诊断确定性值（MDCVs）。最终诊断由手术、阑尾切除标本的病理评估或临床随访结果确定。比较POCUS和RADUS的敏感性、特异性、阳性似然比（PLR）和阴性似然比（NLR）以及MDCVs的POCUS前后VAS评分。
共有264例患者纳入最终分析，其中169例（64%）诊断为AA。POCUS超声检查的敏感性、特异性、PLR和NLR分别为92.3%（95%置信区间[CI]=87.2%-95.8%）、95.8%（89.5%-98.8%）、21.9（8.4-57.2）和0.08（0.05-0.1），RADUS分别为76.9%（69.8-83%）、97.8%（84.9-99.7%）、36.4（9.25-144.3）和0.24（0.18-0.31）。MDCVs的POCUS前和POCUS后VAS评分分别为60（四分位间距[IQR]=50-65）和95（IQR=20-98）（p = 0.000）。
在急诊科对AA进行诊断时，床旁超声检查具有较高的敏感性和特异性，对急诊医生的临床决策有积极影响。
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