Clinical Trial Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China; Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Clinical Trial Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
J Pediatr Surg. 2023 Oct;58(10):1886-1892. doi: 10.1016/j.jpedsurg.2023.02.060. Epub 2023 Mar 6.
Relevant guidelines recommend the use of the Alvarado score (AS) to assist in the diagnosis of acute appendicitis (AA) in children. To provide reference evidence for the clinical application of AS, we performed a meta-analysis of studies related to the diagnostic accuracy of AS in children with AA.
We searched the relevant literature from databases including CNKI, WanFangdata, VIP, CBM, the Cochrane Library, PubMed, Embase, and Web of Science databases from the date of database creation to April 30, 2022, and screened them according to nadir criteria, followed by data extraction and then combined effect sizes to assess the accuracy of AS for diagnosis in children.
Twenty-six studies involving 2579 cases were finally included, including 19 studies with Alvarado score and 8 studies with modified Alvarado Score (1 study included both Alvarado Score and modified Alvarado Score). The combined sensitivity (SE) of AS for diagnosing AA in children was 76.0% (95% CI 74.0-78.0%; I = 95.1%); combined specificity (SP) was 71.0% (95% CI 68.0-74.0%; I = 86.4%); combined positive likelihood ratio (LR+) was 2.43 (95% CI 1.92- 3.07; I = 78.7%); combined negative likelihood ratio (LR-) was 0.28 (95% CI 0.20-0.41; I = 94.2%); combined AUC = 0.8092, Q∗ = 0.7439; combined diagnostic ratio (DOR) was 8.96 (95% CI 5.65 -14.21; I = 76.2%). The combined effect size I was greater than 50% for all children with a modified AS diagnosis of AA, so all analyses used a random-effects model, which showed a combined SE of 87.0% (95% CI 85.0 - 88.0%; I = 85.5%); the combined SP was 47.0% (95% CI 43.0 - 51.0%. I = 88.7%); combined LR+ was 1.68 (95% CI 1.31-2.17; I = 85.9%); combined LR-was 0.28 (95% CI 0.20-0.39; I = 74.3%); combined AUC = 0.8672 and Q∗ = 0.7978. The combined DOR was 6.43 (95% CI 3.38-12.26; I = 80.0%).
The results of this meta-analysis suggest that the accuracy of AS in diagnosing AA in children is moderate, and AS can be an auxiliary tool for the diagnosis of AA in children, relying on AS alone for the diagnosis of AA is not recommended; AS can be further improved scientifically to increase its diagnostic value.
相关指南建议使用 Alvarado 评分（AS）来协助儿童急性阑尾炎（AA）的诊断。为了为 AS 在儿童 AA 中的诊断准确性的临床应用提供参考证据，我们对有关 AS 在儿童 AA 中的诊断准确性的研究进行了荟萃分析。
我们从中国知网、万方数据、维普、CBM、Cochrane 图书馆、PubMed、Embase 和 Web of Science 数据库中检索了从数据库创建日期到 2022 年 4 月 30 日的相关文献，并根据最低标准进行了筛选，然后进行了数据提取，再合并效应量以评估 AS 在儿童中的诊断准确性。
最终纳入了 26 项研究，共涉及 2579 例，其中 19 项研究使用了 Alvarado 评分，8 项研究使用了改良 Alvarado 评分（1 项研究同时使用了 Alvarado 评分和改良 Alvarado 评分）。AS 诊断儿童 AA 的综合敏感性（SE）为 76.0%（95%CI 74.0-78.0%；I=95.1%）；综合特异性（SP）为 71.0%（95%CI 68.0-74.0%；I=86.4%）；综合阳性似然比（LR+）为 2.43（95%CI 1.92-3.07；I=78.7%）；综合阴性似然比（LR-）为 0.28（95%CI 0.20-0.41；I=94.2%）；综合 AUC=0.8092，Q*=0.7439；综合诊断比值比（DOR）为 8.96（95%CI 5.65-14.21；I=76.2%）。所有用改良 AS 诊断为 AA 的儿童的合并效应量 I 均大于 50%，因此所有分析均使用随机效应模型，显示综合 SE 为 87.0%（95%CI 85.0-88.0%；I=85.5%）；综合 SP 为 47.0%（95%CI 43.0-51.0%；I=88.7%）；综合 LR+为 1.68（95%CI 1.31-2.17；I=85.9%）；综合 LR-为 0.28（95%CI 0.20-0.39；I=74.3%）；综合 AUC=0.8672，Q*=0.7978。综合 DOR 为 6.43（95%CI 3.38-12.26；I=80.0%）。
本荟萃分析结果表明，AS 诊断儿童 AA 的准确性为中等，AS 可以作为儿童 AA 诊断的辅助工具，不建议单独依靠 AS 来诊断 AA；可以进一步科学地改进 AS，以提高其诊断价值。
