Ramirez J M, Deus J
Departamento de Cirugia, Hospital Clinico Universitario, Zaragoza, Spain.
Br J Surg. 1994 May;81(5):680-3. doi: 10.1002/bjs.1800810516.
During recent years different procedures have been used to assist in diagnosis of questionable cases of appendicitis. Among these methods, there are few scoring systems that have been shown to be effective. The aim of this study was to create a scoring system and to test its accuracy in the preoperative diagnosis of acute appendicitis. Clinical data from 360 patients who had undergone appendicectomy were collected to identify attributes that distinguished patients having a negative laparotomy from those with appendicitis. Seven independent criteria were identified. Using Bayesian methodology a weight was given to each criterion and an overall score calculated. A cut-off point was identified to separate patients for surgery and those for observation. The scoring system was applied prospectively to 166 consecutive patients; 134 had appendicitis and 32 a normal appendix (19.3 per cent error diagnosis). For the 166 patients the method suggested surgery in 113, 107 (94.7 per cent) of whom were found to have appendicitis. The system suggested observation in hospital in 38 cases. For the whole group the scoring system showed a sensitivity of 80 per cent and specificity of 81 per cent. Scoring systems from a local database could become the ideal complementary method in the diagnosis of suspected acute appendicitis.
近年来，人们采用了不同的方法来辅助诊断可疑的阑尾炎病例。在这些方法中，很少有评分系统被证明是有效的。本研究的目的是创建一个评分系统，并测试其在急性阑尾炎术前诊断中的准确性。收集了360例行阑尾切除术患者的临床数据，以确定区分剖腹探查阴性患者和阑尾炎患者的特征。确定了七个独立标准。使用贝叶斯方法对每个标准赋予权重并计算总分。确定了一个分界点，以区分需要手术的患者和需要观察的患者。该评分系统前瞻性地应用于166例连续患者；134例患有阑尾炎，32例阑尾正常（误诊率为19.3%）。对于这166例患者，该方法建议113例进行手术，其中107例（94.7%）被发现患有阑尾炎。该系统建议38例住院观察。对于整个组，评分系统的敏感性为80%，特异性为81%。来自本地数据库的评分系统可能成为疑似急性阑尾炎诊断的理想辅助方法。
