疑似阑尾炎的诊断准确性：儿童误诊阑尾炎的对比分析。

Diagnostic Accuracy of Suspected Appendicitis: A Comparative Analysis of Misdiagnosed Appendicitis in Children.

机构信息

University of Nebraska Medical Center, Omaha, NE.

From the Section of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine.

出版信息

Pediatr Emerg Care. 2022 Feb 1;38(2):e690-e696. doi: 10.1097/PEC.0000000000002323.

DOI:10.1097/PEC.0000000000002323

PMID:34170096

Abstract

OBJECTIVE

When evaluating suspected appendicitis, limited data support quality benchmarks for negative appendectomy (NA); none exist for delayed diagnosis of appendicitis (DDA). The objectives of this study are the following: (1) to provide preliminary evidence supporting a quality benchmark for DDA and 2) to compare presenting features and diagnostic evaluations of children with NA and DDA with those with pathology-confirmed appendicitis (PCA) diagnosed during initial emergency department (ED) encounter.

METHODS

Secondary analysis of data from a QI project designed to reduce the use computed tomography when evaluating suspected appendicitis using a case-control design. Patients undergoing appendectomy in an academic tertiary care children's hospital system between January 1, 2015, and December 31, 2016 (n = 1,189) were eligible for inclusion in this case-control study. Negative appendectomy was defined as no pathologic change or findings consistent with a different diagnosis. Delayed diagnosis of appendicitis was defined as patients undergoing appendectomy within 7 days of a prior ED visit for a related complaint. Controls of PCA (n = 150) were randomly selected from all cases undergoing appendectomy.

RESULTS

There were 42 NA (3.5%) and 31 DDA (2.6%). Cases of PCA and NA exhibited similar histories, examination findings, and underwent comparable diagnostic evaluations. Cases of PCA more frequently demonstrated a white blood cell count greater than 10 × 103/μL (85% vs 67%; P = 0.01), a left-shift (77% vs 45%; P < 0.001), and an ultrasound interpretation with high probability for appendicitis (73% vs 54%; P = 0.03). Numerous significant differences in history, examination findings, and diagnostic tests performed existed between cases of PCA and DDA.

CONCLUSIONS

Children with PCA and NA present similarly and undergo comparable evaluations resulting in appendectomy. A 3% to 4% NA rate may be unavoidable given these similarities. Presenting features in DDA significantly differ from those of PCA. An irreducible proportion of appendicitis diagnoses may be delayed.

摘要

目的

在评估疑似阑尾炎时，关于阴性阑尾切除术（negative appendectomy，NA）的质量基准数据有限[1]；而对于阑尾炎的延迟诊断（delayed diagnosis of appendicitis，DDA），则尚无此类基准[2]。本研究的目的如下：（1）为 DDA 提供初步支持质量基准的证据；（2）比较 NA 和 DDA 患儿与经初始急诊（ED）就诊时病理确诊阑尾炎（pathology-confirmed appendicitis，PCA）患儿的表现特征和诊断评估。

方法

采用病例对照设计，对旨在减少疑似阑尾炎患者使用计算机断层扫描（computed tomography，CT）的质量改进项目的数据进行二次分析。本病例对照研究纳入 2015 年 1 月 1 日至 2016 年 12 月 31 日期间在一家学术性三级儿童保健医院系统中接受阑尾切除术的患者（n=1189）。阴性阑尾切除术定义为无病理改变或与其他诊断相符的发现。阑尾炎的延迟诊断定义为在相关症状首次 ED 就诊后 7 天内接受阑尾切除术的患者。随机从所有接受阑尾切除术的患者中选择 PCA（n=150）作为对照。

结果

42 例为 NA（3.5%），31 例为 DDA（2.6%）。PCA 和 NA 病例的病史、检查结果相似，接受了相似的诊断评估。PCA 病例的白细胞计数大于 10×103/μL（85%比 67%；P=0.01）、左移（77%比 45%；P＜0.001）和超声检查结果高度提示阑尾炎（73%比 54%；P=0.03）的比例更高。PCA 和 DDA 病例在病史、检查结果和诊断检查的多个显著差异。