Blumfield Einat, Yang Daniel, Grossman Joshua
Department of Radiology, Albert Einstein College of Medicine/Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, USA.
Department of Pediatrics, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY, USA.
Emerg Radiol. 2017 Oct;24(5):547-554. doi: 10.1007/s10140-017-1535-1. Epub 2017 Jul 7.
Appendicitis is the most common indication for emergency pediatric surgery and its most significant complication is perforation. Perforated appendicitis (PA) may be managed conservatively, whereas non-perforated appendicitis (NP) is managed surgically. Recent studies have shown that ultrasound (US) is effective for differentiating between PA and NP, and does not expose pediatric patients to ionizing radiation. The purpose of this study is to enhance the accuracy of differentiation with a novel scoring system based on clinical, laboratory, and US findings.
This retrospective study included 243 patients aged 2-17 years who presented between 2006 and 2013 with surgically proven appendicitis, of whom 60 had perforation. Clinical and laboratory data were collected and US images evaluated by a pediatric radiologist. To create the scoring system, point values were assigned to each parameter. A randomly selected training sample of 137 subjects was used to create a scoring prediction model. The model was tested on the remaining 106 patients.
Scores of ≥6, ≥11, and ≥15 yielded specificities of 64, 91, and 99%, and sensitivities of 96, 61, and 29%, respectively (p < 0.001).
We have designed a scoring system incorporating clinical, laboratory, and sonographic findings which can differentiate PA from NP with high specificity.
阑尾炎是小儿急诊外科最常见的病症，其最严重的并发症是穿孔。穿孔性阑尾炎（PA）可采用保守治疗，而非穿孔性阑尾炎（NP）则需手术治疗。最近的研究表明，超声（US）可有效区分PA和NP，且不会让儿科患者暴露于电离辐射。本研究的目的是基于临床、实验室和超声检查结果，通过一种新的评分系统提高鉴别诊断的准确性。
这项回顾性研究纳入了2006年至2013年间出现经手术证实的阑尾炎的243例2至17岁患者，其中60例有穿孔。收集临床和实验室数据，并由儿科放射科医生评估超声图像。为创建评分系统，为每个参数赋予分值。使用随机选择的137名受试者的训练样本创建评分预测模型。该模型在其余106例患者身上进行测试。
评分≥6、≥11和≥15时，特异性分别为64%、91%和99%，敏感性分别为96%、61%和29%（p<0.001）。
我们设计了一种结合临床、实验室和超声检查结果的评分系统，该系统可高度特异性地鉴别PA和NP。
