The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza Suite 404D, Houston, TX 77030; Division of Pediatric Surgery, Texas Children's Hospital, 6701 Fannin Street Suite 1210, Houston, TX 77030.
The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza Suite 404D, Houston, TX 77030; Division of Pediatric Surgery, Texas Children's Hospital, 6701 Fannin Street Suite 1210, Houston, TX 77030.
J Pediatr Surg. 2019 Nov;54(11):2274-2278. doi: 10.1016/j.jpedsurg.2019.04.007. Epub 2019 Apr 24.
Clinical prediction of disease severity is important as one considers nonoperative management of simple appendicitis. This study assesses the accuracy of surgeons' prediction of appendicitis severity.
From February to August 2016, pediatric surgeons at a single institution were asked to predict whether patients had simple or complex appendicitis preoperatively based on clinical data, imaging, and general assessment. Receiver operating characteristic curves were generated to determine area under the curve (AUC) and optimal cutoff points of clinical findings for diagnosing simple appendicitis. Outcomes included sensitivity and specificity of variables to identify simple appendicitis. Predictions were compared to operative findings using χ. A p-value<0.05 was considered statistically significant.
Of 125 cases (median age 9 years [IQR 7-13], 58% male), simple appendicitis was predicted in 77 (62%) and complex appendicitis in 48 (38%). Predictions were accurate in 59 (77%) simple cases and 45 (94%) complex cases. Although surgeon prediction was more accurate than individual imaging or clinical findings and was highly sensitive (95%) for diagnosing simple appendicitis, specificity was only 71%. Lower WBC (<15.5 × 10/μL, AUC 0.61, p = 0.05), afebrile (<100.4 °F, AUC 0.86, p < 0.01), and shorter symptom duration (≤ 1.5 days, AUC 0.71, p < 0.001) were associated with simple appendicitis. Of 18 complex cases (14%) inaccurately predicted as simple, 17 (94%) lacked diffuse tenderness, 15 (83%) were well-appearing, 11 (61%) had ultrasound findings of simple appendicitis, 11 (61%) had ≤2 days of symptoms, and 8 (44%) were afebrile (<100.4 °F).
While surgeon prediction of simple appendicitis is more accurate than ultrasound or clinical data alone, diagnostic accuracy is still limited.
Prospective survey.
II.
在考虑对单纯性阑尾炎进行非手术治疗时，临床预测疾病严重程度非常重要。本研究评估了外科医生对阑尾炎严重程度预测的准确性。
2016 年 2 月至 8 月，一家医疗机构的小儿外科医生根据临床数据、影像学检查和整体评估，术前预测患者是否患有单纯性或复杂性阑尾炎。生成受试者工作特征曲线以确定曲线下面积（AUC）和用于诊断单纯性阑尾炎的最佳临床发现截断值。结果包括变量识别单纯性阑尾炎的敏感性和特异性。使用 χ 比较预测值与手术结果。p 值＜0.05 被认为具有统计学意义。
125 例患者（中位数年龄 9 岁[IQR 7-13]，58%为男性）中，77 例（62%）预测为单纯性阑尾炎，48 例（38%）为复杂性阑尾炎。59 例（77%）单纯性病例和 45 例（94%）复杂性病例的预测结果准确。尽管外科医生的预测比单独的影像学或临床发现更准确，且对诊断单纯性阑尾炎的敏感性高（95%），但特异性仅为 71%。白细胞计数较低（＜15.5×10/μL，AUC 0.61，p=0.05）、不发热（＜100.4°F，AUC 0.86，p＜0.01）和症状持续时间较短（≤1.5 天，AUC 0.71，p＜0.001）与单纯性阑尾炎相关。18 例（14%）复杂病例被错误地预测为单纯性病例，其中 17 例（94%）缺乏弥漫性压痛，15 例（83%）表现良好，11 例（61%）超声检查显示单纯性阑尾炎，11 例（61%）症状持续时间≤2 天，8 例（44%）不发热（＜100.4°F）。
虽然外科医生对单纯性阑尾炎的预测准确性高于单独的超声或临床数据，但诊断准确性仍然有限。
前瞻性调查。
Ⅱ。
