急诊医生超声筛查急性阑尾炎的准确性；一项横断面研究。

The Accuracy of Emergency Physicians in Ultrasonographic Screening of Acute Appendicitis; a Cross Sectional Study.

作者信息

Karimi Ebrahim, Aminianfar Mohammad, Zarafshani Keivan, Safaie Arash

机构信息

Emergency Department, Be'sat Hospital, Aja University of Medical Sciences, Tehran, Iran.

Department of Infectious and Tropical Diseases, Be'sat Hospital, Aja University of Medical Sciences, Tehran, Iran.

出版信息

Emerg (Tehran). 2017;5(1):e22. Epub 2017 Jan 10.

PMID:28286829

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5325891/

Abstract

INTRODUCTION

Diagnostic values reported for ultrasonographic screening of acute appendicitis vary widely and are dependent on the operator's skill, patient's gender, weight, etc. The present study aimed to evaluate the effect of operator skill on the diagnostic accuracy of ultrasonography in detection of appendicitis by comparing the results of ultrasonography done by radiologists and emergency physicians.

METHODS

This prospective diagnostic accuracy was carried out on patients suspected to acute appendicitis presenting to EDs of 2 hospitals. After the initial clinical examinations, all the patients underwent ultrasonography for appendicitis by emergency physician and radiologist, respectively. The final diagnosis of appendicitis was based on either pathology report or 48-hour follow-up. Screening performance characteristics of appendix ultrasonography by emergency physician and radiologist were compared using STATA 11.0 software.

RESULTS

108 patients with the mean age of 23.91 ± 7.46 years were studied (61.1% male). Appendicitis was confirmed for 37 (34.26%) cases. Cohen's kappa coefficient between ultrasonography by the radiologist and emergency physician in diagnosis of acute appendicitis was 0.51 (95% CI: 0.35 - 0.76). Area under the ROC curve of ultrasonography in appendicitis diagnosis was 0.78 (95% CI: 0.69 - 0.86) for emergency physician and 0.88 (95% CI: 0.81 - 0.94) for radiologist (p = 0.052). Sensitivity and specificity of ultrasonography by radiologist and emergency physician in appendicitis diagnosis were 83.87% (95% CI: 67.32 - 93.23), 91.5% (95% CI: 81.89 - 96.52), 72.97% (95% CI: 55.61 - 85.63), and 83.10% (95% CI: 71.94 - 90.59), respectively.

CONCLUSION

Findings of the present study showed that the diagnostic accuracy of ultrasonography carried out by radiologist (89%) is a little better compared to that of emergency physician (80%) in diagnosis of appendicitis, but none are excellent.

摘要

引言

超声筛查急性阑尾炎所报告的诊断价值差异很大，并且取决于操作者的技能、患者的性别、体重等因素。本研究旨在通过比较放射科医生和急诊科医生进行超声检查的结果，评估操作者技能对超声诊断阑尾炎准确性的影响。

方法

对两家医院急诊科疑似急性阑尾炎的患者进行了这项前瞻性诊断准确性研究。在初步临床检查后，所有患者分别由急诊科医生和放射科医生进行阑尾炎超声检查。阑尾炎的最终诊断基于病理报告或48小时随访结果。使用STATA 11.0软件比较急诊科医生和放射科医生进行阑尾超声检查的筛查性能特征。

结果

研究了108例患者，平均年龄为23.91±7.46岁（男性占61.1%）。确诊阑尾炎的有37例（34.26%）。放射科医生和急诊科医生超声检查诊断急性阑尾炎的Cohen's kappa系数为0.51（95%CI：0.35 - 0.76）。急诊科医生阑尾炎诊断超声检查的ROC曲线下面积为0.78（95%CI：0.69 - 0.86），放射科医生为0.88（95%CI：0.81 - 0.94）（p = 0.052）。放射科医生和急诊科医生超声检查诊断阑尾炎的敏感性和特异性分别为83.87%（CI：67.32 - 93.23）、91.5%（95%CI：81.89 - 96.52）、72.97%（95%CI：55.61 - 85.63）和83.10%（95%CI：71.94 - 90.59）。