Feng Hui, Yu Qingsheng, Wang Jingxing, Yuan Yiyang, Yu Shushan, Wei Feisheng, Zheng Zhou, Peng Hui, Zhang Wanzong
General surgery department, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China.
Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China.
Front Surg. 2022 Jun 9;9:905075. doi: 10.3389/fsurg.2022.905075. eCollection 2022.
For elderly patients with mild clinical symptoms of uncomplicated appendicitis(UA), non-surgical treatment has been shown to be feasible, whereas emergency surgical treatment is recommended in elderly patients with complicated appendicitis(CA), but it is still challenging to accurately distinguish CA and UA before treatment. This study aimed to develop a predictive model to assist clinicians to quickly determine the type of acute appendicitis.
We retrospectively studied the clinical data of elderly patients with acute appendicitis who visited the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2012 to January 2022. The patients were divided into UA group and CA group, and the general conditions, medical history, physical examination, laboratory examination and imaging examination were compared between the two groups, and SPSS 26.0 and R 4.0.2 software were used to establish CA clinic. Predict the model, and validate it internally.
The clinical data of 441 elderly patients with acute appendicitis were collected, 119 patients were excluded due to incomplete clinical data or other diseases. Finally, 332 patients were included in the study and divided into UA group ( = 229) and CA group ( = 103). By analyzing the clinical data of the two groups of patients, the duration of abdominal pain [OR = 1.094, 95% CI (1.056-1.134)], peritonitis [OR = 8.486, 95% CI (2.017-35.703))] and total bilirubin [OR = 1.987, 95% CI (1.627-2.426)] were independent predictors of CA (all < 0.01). The model's Area Under Curve(AUC) = 0.985 (95% CI, 0.975-0.994). After internal verification by Bootstrap method, the model still has high discriminative ability (AUC = 0.983), and its predicted CA curve is still in good agreement with the actual clinical CA curve.
We found that a clinical prediction model based on abdominal pain duration, peritonitis, and total bilirubin can help clinicians quickly and effectively identify UA or CA before treatment of acute appendicitis in the elderly, so as to make more scientific clinical decisions.
对于临床症状较轻的老年单纯性阑尾炎（UA）患者，非手术治疗已被证明是可行的，而对于老年复杂性阑尾炎（CA）患者，建议进行急诊手术治疗，但在治疗前准确区分CA和UA仍具有挑战性。本研究旨在建立一种预测模型，以协助临床医生快速确定急性阑尾炎的类型。
我们回顾性研究了2012年1月至2022年1月在安徽中医药大学第一附属医院就诊的老年急性阑尾炎患者的临床资料。将患者分为UA组和CA组，比较两组患者的一般情况、病史、体格检查、实验室检查和影像学检查，并使用SPSS 26.0和R 4.0.2软件建立CA临床预测模型，并进行内部验证。
收集了441例老年急性阑尾炎患者的临床资料，119例因临床资料不完整或合并其他疾病被排除。最终，332例患者纳入研究，分为UA组（n = 229）和CA组（n = 103）。通过分析两组患者的临床资料，腹痛持续时间[OR = 1.094，95%CI（1.056 - 1.134）]、腹膜炎[OR = 8.486，95%CI（2.017 - 35.703）]和总胆红素[OR = 1.987，95%CI（1.627 - 2.426）]是CA的独立预测因素（均P < 0.01）。该模型的曲线下面积（AUC）= 0.985（95%CI，0.975 - 0.994）。经Bootstrap法内部验证后，该模型仍具有较高的判别能力（AUC = 0.983），其预测的CA曲线与实际临床CA曲线仍具有良好的一致性。
我们发现基于腹痛持续时间、腹膜炎和总胆红素的临床预测模型可帮助临床医生在老年急性阑尾炎治疗前快速有效地识别UA或CA，从而做出更科学的临床决策。
