疑似急性阑尾炎患者中阿尔瓦拉多标准、超声、C反应蛋白及其联合应用的评估：一项单中心研究

Assessment of Alvarado criteria, ultrasound, CRP, and their combination in patients with suspected acute appendicitis: a single centre study.

作者信息

Tayebi Ali, Olamaeian Faranak, Mostafavi Keihan, Khosravi Kasra, Tizmaghz Adnan, Bahardoust Mansour, Zakaryaei Alireza, Mehr Daniyal Enayat

机构信息

Firoozabadi Clinical Research Development Unit (F A CRD U) School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.

Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

出版信息

BMC Gastroenterol. 2024 Jul 31;24(1):243. doi: 10.1186/s12876-024-03333-5.

DOI:10.1186/s12876-024-03333-5

PMID:39085761

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11289915/

Abstract

BACKGROUND

Acute appendicitis (AA) is one of the most common reasons for visiting the emergency room. The lack of proper diagnosis and rapid treatment of AA may lead to severe complications such as intestinal perforation and increased mortality. This study aimed to evaluate the diagnostic accuracy of the Alvarado criteria, ultrasound, and CRP criteria in comparison with their combined use in patients with suspected AA who presented to the emergency room.

METHODS

In this diagnostic accuracy study, 1411 patients with suspected AA who presented to the emergency department of Firoozabadi Hospital affiliated with Iran University of Medical Sciences and underwent appendectomy from October 2019 to October 2021 were examined. Nine hundred eighty-eight patients were enrolled. All patients were assessed using Alvarado, CRP, and ultrasound. The definitive diagnosis of AA was based on pathological findings and was considered the gold standard. Statistical analyses were performed with STATA VER 11.5. The diagnostic accuracy for each group was compared using the Pearson chi-square test. A value of p < 0.05 was considered statistically significant.

RESULTS

The mean age was 29.57 ± 13.66 years. The sensitivity and specificity of Alvarado in the diagnostic accuracy of appendicectomy were 75.2% and 61.3% (CI = 95%), respectively. The sensitivity of ultrasound and CRP for predicting appendicitis was significantly higher than the Alvarado criteria. The diagnostic accuracy for CRP was significantly higher than ultrasound (64.9% vs. 60.7%, P: 0.003). The diagnostic accuracy of the simultaneous use of Alvarado + CRP and CRP + Ultrasound was significantly higher than that of Alvarado + ultrasound. The sensitivity, specificity, and diagnostic accuracy of the simultaneous use of all three criteria together (Alvarado + Ultrasound + CRP) were estimated to be 94.9%, 25.8%, and 81.5% (CI = 95%), respectively, which were significantly higher than the use of other criteria.

CONCLUSION

This study showed that the Alvarado criteria had inadequate diagnostic sensitivity and accuracy for diagnosing acute appendicitis. The diagnostic accuracy of acute appendicitis increases to over 90% using the three Alvarado, ultrasound, and CRP criteria at the same time.

摘要

背景

急性阑尾炎（AA）是急诊就诊的最常见原因之一。AA缺乏正确诊断和快速治疗可能导致严重并发症，如肠穿孔和死亡率增加。本研究旨在评估阿尔瓦拉多标准、超声和CRP标准在与联合使用这些标准时对疑似AA且到急诊室就诊患者的诊断准确性。

方法

在这项诊断准确性研究中，对2019年10月至2021年10月到伊朗医科大学附属菲鲁扎巴迪医院急诊科就诊并接受阑尾切除术的1411例疑似AA患者进行了检查。纳入了988例患者。所有患者均采用阿尔瓦拉多、CRP和超声进行评估。AA的确诊基于病理结果，并被视为金标准。使用STATA VER 11.5进行统计分析。采用Pearson卡方检验比较每组的诊断准确性。p值<0.05被认为具有统计学意义。

结果

平均年龄为29.57±13.66岁。阿尔瓦拉多在阑尾切除诊断准确性方面的敏感性和特异性分别为75.2%和61.3%（CI = 95%）。超声和CRP预测阑尾炎的敏感性显著高于阿尔瓦拉多标准。CRP的诊断准确性显著高于超声（64.9%对60.7%，P：0.003）。同时使用阿尔瓦拉多+CRP和CRP+超声的诊断准确性显著高于阿尔瓦拉多+超声。同时使用所有三项标准（阿尔瓦拉多+超声+CRP）的敏感性、特异性和诊断准确性估计分别为94.9%、25.8%和81.5%（CI = 95%），显著高于使用其他标准。