Ghali Mohamed Said, Hasan Samer, Al-Yahri Omer, Mansor Salah, Al-Tarakji Mohannad, Obaid Munzir, Shah Amjad Ali, Shehata Mona S, Singh Rajvir, Al-Zoubi Raed M, Zarour Ahmad
Department of Surgery, Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar.
Department of General Surgery, Ain Shams University, Cairo, Egypt.
Surg Open Sci. 2023 Jul 20;14:96-102. doi: 10.1016/j.sopen.2023.07.007. eCollection 2023 Aug.
Acute Appendicitis (AA) is the most common abdominal surgical emergency. It requires proper management to decrease mortality and morbidity. Clinical scoring systems for diagnosing AA aimed to decrease the use of radiological scans and the rate of negative appendectomies (NA). We aim to assess the adult appendicitis score (AAS) in the diagnosis prediction of AA.
A retrospective study with 1303 cases of AA is performed. We compared the correlation of AAS and Alvarado scores to postoperative histopathology. Specificity, sensitivity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were assessed. ROC was used.
AAS risk stratification was applied to the study population. Group I for a low probability, and groups II and III for an intermediate and high probability of AA. We found that 159 patients were matched in group I, 505, and 639 were in groups II and III of AAS, respectively. The correlation between Alvarado and AAS with HP was significant. AAS ≥ 16 presented sensitivity and specificity of 50 % and 75.47 %, respectively, with PPV of 97.96 % and NPV of 6.02 %, with an accuracy of 51.04 %. Regarding AAS ≥ 11, the sensitivity was 88.96 %, specificity was 39.62 %, PPV was 97.2 %, NPV was 13.21 %, and accuracy was 86.95 %.
AAS is relatively more accurate than Alvarado's score, especially in selecting a safe candidate for discharge from an emergency. In addition, AAS is found to decrease the need for radiological images and NA rate more than Alvarado.
急性阑尾炎（AA）是最常见的腹部外科急症。需要进行恰当的处理以降低死亡率和发病率。用于诊断AA的临床评分系统旨在减少放射学检查的使用以及阴性阑尾切除术（NA）的发生率。我们旨在评估成人阑尾炎评分（AAS）在AA诊断预测中的作用。
对1303例AA病例进行回顾性研究。我们将AAS和阿尔瓦拉多评分与术后组织病理学结果进行相关性比较。评估了特异性、敏感性、阳性预测值（PPV）和阴性预测值（NPV）。采用了ROC曲线。
将AAS风险分层应用于研究人群。I组为低概率组，II组和III组为AA的中概率和高概率组。我们发现I组有159例患者匹配，AAS的II组和III组分别有505例和639例。阿尔瓦拉多评分和AAS与组织病理学的相关性显著。AAS≥16时，敏感性和特异性分别为50%和75.47%，PPV为97.96%，NPV为6.02%，准确率为51.04%。对于AAS≥11，敏感性为88.96%，特异性为39.62%，PPV为97.2%，NPV为13.21%，准确率为86.95%。
AAS比阿尔瓦拉多评分相对更准确，尤其是在选择可安全出院的急诊患者方面。此外，发现AAS比阿尔瓦拉多评分更能减少对放射学影像的需求和NA发生率。
