Aboulwafa Amr Mohamed F, Aboulwafa Ali A, Ahmad Khalil, Abouzour Mazin, Khairallah Amira
Surgery, Westbay Medicare Hospital, Doha, QAT.
Medicine, Weill Cornell Medicine - Qatar, Doha, QAT.
Cureus. 2024 Sep 25;16(9):e70222. doi: 10.7759/cureus.70222. eCollection 2024 Sep.
Introduction Acute appendicitis, a prevalent cause of acute abdominal pain and a common indication for emergency surgery, presents a diagnostic challenge due to its diverse clinical presentation and variability in appendix location and symptoms. Traditional diagnostic approaches, including physical examination, clinical scoring systems, and imaging techniques, have limitations. This study introduces the "Amr sign," a new diagnostic indicator characterized by sudden reflex hyperextension of the neck upon palpation of the right iliac fossa, which is hypothesized to reflect local peritoneal irritation from an inflamed appendix. Methods We conducted a prospective observational study at Alwakra Hospital from November 2016 to January 2019 that included 195 patients aged 15 years and older with right iliac fossa pain and an Alvarado score of four or more. The "Amr sign" was evaluated alongside standard clinical examination and imaging results. Diagnostic accuracy was assessed via histopathological confirmation, which is the gold standard. Results The "Amr sign" had a sensitivity of 68.6% and a specificity of 67.3%. The positive predictive value (PPV) was 89%, whereas the negative predictive value (NPV) was 45%. Receiver operating characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.679 for the "Amr sign" compared with 0.622 for the other imaging modalities, suggesting comparable diagnostic performance. The "Amr sign" demonstrated a higher likelihood ratio of a positive test (2.3) and a lower likelihood ratio of a negative test (0.46). Conclusion The "Amr sign" is a promising diagnostic tool for acute appendicitis, offering a simple, reliable, and quick test that can be performed by less experienced physicians. While its sensitivity and specificity are moderate, its high PPV suggests that it is particularly useful in confirming appendicitis. Further research and validation are needed to fully establish its role in clinical practice.
引言
急性阑尾炎是急性腹痛的常见病因，也是急诊手术的常见指征，因其临床表现多样、阑尾位置及症状存在变异性，故诊断颇具挑战性。包括体格检查、临床评分系统及影像学技术在内的传统诊断方法均有局限性。本研究引入了“阿姆尔征”，这是一种新的诊断指标，其特征为触诊右髂窝时颈部突然反射性过伸，据推测这反映了发炎阑尾引起的局部腹膜刺激。
方法
我们于2016年11月至2019年1月在阿尔瓦克拉医院开展了一项前瞻性观察性研究，纳入了195例年龄在15岁及以上、有右髂窝疼痛且阿尔瓦拉多评分在4分及以上的患者。对“阿姆尔征”与标准临床检查及影像学结果进行了评估。通过组织病理学确诊（这是金标准）来评估诊断准确性。
结果
“阿姆尔征”的敏感性为68.6%，特异性为67.3%。阳性预测值（PPV）为89%，而阴性预测值（NPV）为45%。受试者工作特征（ROC）分析显示，“阿姆尔征”的曲线下面积（AUC）为0.679，其他影像学检查方法的AUC为0.622，提示二者诊断性能相当。“阿姆尔征”的阳性试验似然比更高（2.3），阴性试验似然比更低（0.46）。
结论
“阿姆尔征”是一种有前景的急性阑尾炎诊断工具，提供了一种简单、可靠且快速的检查方法，经验不足的医生也可操作。虽然其敏感性和特异性中等，但其较高的PPV表明它在确诊阑尾炎方面特别有用。需要进一步的研究和验证来全面确立其在临床实践中的作用。
