General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
Faculty of Health Sciences, Valencian International University (VIU), Valencia, Spain.
World J Surg. 2024 Jun;48(6):1350-1359. doi: 10.1002/wjs.12160. Epub 2024 Mar 28.
Controversies remain on the diagnostic strategy in suspected AA, considering the different settings worldwide.
A prospective observational international multicentric study including patients operated for suspected AA with a definitive histopathological analysis was conducted. Three groups were analyzed: (1) No radiology; (2) Ultrasound, and (3) Computed tomography. The aim was to analyze the performance of three diagnostic schemes.
Three thousand and one hundred twenty three patients were enrolled; 899 in the no radiology group, 1490 in the US group, and 734 in the CT group. The sex ratio was in favor of males (p < 0.001). The mean age was lower in the no radiology group (24 years) compared to 28 and 38 years in US and CT-scan groups, respectively (p < 0.001). Overall, the negative appendectomy rate 3.8%: no radiology group (5.1%) versus US (2.9%) and CT-scan (4.1%) (p < 0.001). The sensitivity and specificity analysis showed the best balance in clinical evaluation + score + US. These data reach the best results in those patients with an equivocal Alvarado score (4-6). Inverse probability weighting (IPW), showed as the use of ultrasound, is significantly associated with an increased probability of formulating the correct diagnosis (p 0.004). In the case of a CT scan, this association appears weaker (p 0.08).
The association of clinical scores and ultrasound seems the best strategy to reach a correct preoperative diagnosis in patients with clinical suspicion of AA, even in those population subgroups where the clinical score may have an equivocal result. This strategy can be especially useful in low-resource settings worldwide. CT-scan association may improve the detection of patients who may potentially be submitted to conservative treatment.
鉴于全球不同的环境，在疑似 AA 中，诊断策略仍存在争议。
进行了一项包括疑似 AA 患者进行确定性组织病理学分析的前瞻性观察性国际多中心研究。分析了三组：（1）无放射学检查；（2）超声检查，（3）计算机断层扫描。目的是分析三种诊断方案的性能。
共纳入 3123 名患者；无放射学组 899 例，超声组 1490 例，CT 组 734 例。男女比例有利于男性（p<0.001）。无放射学组的平均年龄（24 岁）低于超声组（28 岁）和 CT 扫描组（38 岁）（p<0.001）。总体而言，阴性阑尾切除率为 3.8%：无放射学组（5.1%）与超声组（2.9%）和 CT 扫描组（4.1%）（p<0.001）。灵敏度和特异性分析显示，临床评估+评分+超声的平衡最佳。这些数据在那些 Alvarado 评分（4-6）不确定的患者中达到最佳结果。逆概率加权（Inverse probability weighting，IPW）显示，超声的使用与提高正确诊断的可能性显著相关（p<0.004）。对于 CT 扫描，这种关联似乎较弱（p<0.08）。
在临床怀疑 AA 的患者中，临床评分和超声的联合似乎是达到正确术前诊断的最佳策略，即使在临床评分可能存在不确定结果的亚组人群中也是如此。这种策略在全球资源有限的环境中可能特别有用。CT 扫描的联合可能有助于提高对可能接受保守治疗的患者的检测。
