Department of Surgery, Walter Reed National Military Medical Center and The Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Office of Clinical Research, John Peter Smith Health Network, Fort Worth, Texas.
J Surg Res. 2021 May;261:326-333. doi: 10.1016/j.jss.2020.10.021. Epub 2021 Jan 21.
It has been well established that ultrasound (US) is the initial screening tool for children with suspected acute appendicitis. However, computed tomography (CT) has become the standard screening modality for adults presenting with abdominal pain. A recent review of National Surgical Quality Improvement Program (NSQIP) data revealed US is being utilized as a screening modality in adults. We aimed to assess the diagnostic performance of US in evaluating adults with acute appendicitis.
The American College of Surgeons NSQIP and NSQIP Procedure Targeted Data Files were accessed and examined for all patients in 2016 and 2017 who received an US and underwent an appendectomy. The US results were then correlated to the pathology in order to determine the diagnostic performance. Additionally, we identified predictors for indeterminate and false negative US results.
Our study included 3607 appendectomy patients of which 1135 (30%) had an indeterminate US, 683 (18%) had an US not consistent with appendicitis, and 1789 (49%) had an US consistent with appendicitis. Sensitivity and Specificity were 74.3% and 53.0%, respectively. Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 95.9% and 12.2%, respectively. On regression analysis, clinically relevant predictors for false negative and indeterminate studies included age, sex, and BMI.
Ultrasound is an effective initial imaging modality for acute appendicitis in the adult population. Females, age >30 y, and elevated BMI were more likely to have indeterminate or false negative results. These patients may benefit from CT as their initial screening test.
超声（US）已被证实为疑似急性阑尾炎患儿的初始筛查工具。然而，计算机断层扫描（CT）已成为成人腹痛的标准筛查方式。最近对国家外科质量改进计划（NSQIP）数据的审查显示，US 正被用作成人的筛查方式。我们旨在评估 US 在评估成人急性阑尾炎中的诊断性能。
美国外科医师学院 NSQIP 和 NSQIP 手术靶向数据文件被访问和检查，以确定 2016 年和 2017 年所有接受 US 检查并接受阑尾切除术的患者。然后将 US 结果与病理学相关联，以确定诊断性能。此外，我们确定了不确定和假阴性 US 结果的预测因素。
我们的研究包括 3607 例阑尾切除术患者，其中 1135 例（30%）US 结果不确定，683 例（18%）US 结果与阑尾炎不一致，1789 例（49%）US 结果与阑尾炎一致。敏感性和特异性分别为 74.3%和 53.0%。阳性预测值（PPV）和阴性预测值（NPV）分别为 95.9%和 12.2%。回归分析显示，假阴性和不确定研究的临床相关预测因素包括年龄、性别和 BMI。
超声是成人急性阑尾炎的有效初始影像学检查方法。女性、年龄>30 岁和 BMI 升高者更有可能出现不确定或假阴性结果。这些患者可能受益于 CT 作为其初始筛查测试。
