Samir Mohamed, Hefzy Mohamed, Gaber Mohamed, Moghazy Khaled
Medical Research Institute, Alexandria University, Egypt.
Faculty of Medicine, Alexandria University, Egypt.
Afr J Emerg Med. 2016 Sep;6(3):138-143. doi: 10.1016/j.afjem.2016.02.004. Epub 2016 Apr 7.
Acute appendicitis is one of the most common emergencies treated by the general surgeon. Simple appendicitis can progress to perforation, which is associated with a much higher morbidity and mortality, and surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain. The aim of this study was to evaluate the sensitivity and specificity of the Alvarado score combined with ultrasounds of the abdomen and pelvis in cases of right iliac fossa pain with suspected acute appendicitis.
100 patients admitted to the Department of Surgery at Alexandria Main University Hospital in 2013 complaining of right iliac fossa pain with suspected acute appendicitis were studied prospectively. The demographic information, histopathology, physical examination, laboratory data, Alvarado score, sonography report and histopathological reports of these patients were gathered. The treating surgeon made decisions for surgery or conservative management without any intervention from the research team.
A combination of methods showed that Alvarado alone was 100% sensitive in excluding appendicitis at scores below five and was highly specific at scores above eight (91.9%) with no added value when combining it with ultrasound in those scores. On the other hand, ultrasound was beneficial only in patients with Alvarado scores between five and eight for detecting appendicitis and not excluding it (increasing specificity to 100% and not affecting sensitivity).
Ultrasound is a good adjuvant examination in cases with Alvarado scores between five and eight in order to diagnose appendicitis. Negative ultrasound results do not exclude appendicitis and further assessment by other modalities should be performed.
急性阑尾炎是普通外科医生治疗的最常见急症之一。单纯性阑尾炎可发展为穿孔，这与更高的发病率和死亡率相关，因此外科医生倾向于在诊断可能时就进行手术，而不是等到确诊。本研究的目的是评估阿尔瓦拉多评分结合腹部和盆腔超声检查对疑似急性阑尾炎的右下腹疼痛病例的敏感性和特异性。
对2013年入住亚历山大主大学医院外科、主诉疑似急性阑尾炎的右下腹疼痛的100例患者进行前瞻性研究。收集这些患者的人口统计学信息、组织病理学、体格检查、实验室数据、阿尔瓦拉多评分、超声检查报告和组织病理学报告。主治外科医生在没有研究团队任何干预的情况下决定手术或保守治疗。
多种方法联合显示，单独使用阿尔瓦拉多评分时，评分低于5分时排除阑尾炎的敏感性为100%，评分高于8分时特异性很高（91.9%），在这些评分中与超声联合使用时没有附加价值。另一方面，超声仅对阿尔瓦拉多评分在5至8分之间的患者检测阑尾炎有帮助，而不能排除阑尾炎（特异性提高到100%，且不影响敏感性）。
对于阿尔瓦拉多评分在5至8分之间的病例，超声是诊断阑尾炎的良好辅助检查。超声检查结果为阴性不能排除阑尾炎，应通过其他方式进行进一步评估。
