Hillel Yaffe Medical Center, Hadera, Israel.
Radiology Department, Hillel Yaffe Medical Center, Hadera, Israel.
Am J Surg. 2020 Apr;219(4):683-689. doi: 10.1016/j.amjsurg.2019.05.013. Epub 2019 May 25.
We determined whether increasing early imaging (in the emergency department) was associated with earlier surgery and a decrease in complicated appendicitis.
Retrospective study; 3013 operations between 12/2006-12/2016.
Early imaging increased from 13.1% to 74.1%, mostly due to increasing use of ultrasound. Negative appendectomies decreased from 10.7% to 5.1% (p < 0.001). Ultrasound was diagnostic in 80.5%. The false positive rate of ultrasound was 4%. Median time to surgery following positive ultrasound was 7.4 h (IQR 5.8-9.4), shorter compared to no early imaging (13.3 h, IQR 7.2-20.0; p < 0.001). However, median time to surgery following inconclusive and negative ultrasound was 11.5 h (IQR 8.7-16.1) and 17.0 h (IQR 10.3-26.7) respectively. The incidence of complicated appendicitis was 40% and 37.7%, higher than 21.5% in patients with positive US (p < 0.001).
Early imaging resulted in earlier surgery but did not reduce the incidence of complicated appendicitis. Ultrasound averted the need for CT in the majority of patients. When ultrasound was negative or inconclusive, time to surgery was delayed and the rate of complicated appendicitis higher.
我们旨在确定增加早期影像学检查（在急诊科）是否与手术时间提前和复杂阑尾炎发生率降低有关。
回顾性研究；2006 年 12 月至 2016 年 12 月期间的 3013 例手术。
早期影像学检查的比例从 13.1%增加到 74.1%，主要是由于超声检查的应用增加。阴性阑尾切除术的比例从 10.7%下降至 5.1%（p<0.001）。超声检查的诊断准确率为 80.5%。超声检查阳性的假阳性率为 4%。阳性超声检查后手术的中位时间为 7.4 小时（IQR 5.8-9.4），短于无早期影像学检查（13.3 小时，IQR 7.2-20.0；p<0.001）。然而，超声检查结果不确定和阴性的患者手术中位时间分别为 11.5 小时（IQR 8.7-16.1）和 17.0 小时（IQR 10.3-26.7）。复杂阑尾炎的发生率为 40%和 37.7%，高于阳性超声检查患者的 21.5%（p<0.001）。
早期影像学检查导致手术时间提前，但并未降低复杂阑尾炎的发生率。超声检查在大多数患者中避免了 CT 的需要。当超声检查结果为阴性或不确定时，手术时间会延迟，复杂阑尾炎的发生率更高。
