Wade D S, Marrow S E, Balsara Z N, Burkhard T K, Goff W B
Department of Surgery, US Naval Hospital, San Diego, Calif.
Arch Surg. 1993 Sep;128(9):1039-44; discussion 1044-6. doi: 10.1001/archsurg.1993.01420210103014.
To compare the accuracy of the surgeon's clinical diagnosis of acute appendicitis with that of an ultrasonographic examination of the abdomen.
Prospective trial.
US Navel Hospital, San Diego, Calif.
One hundred ten patients admitted to the hospital with suspected appendicitis from May 1990 to June 1992.
Symptoms and signs for each patient were recorded, along with the surgeon's clinical impression of immediate surgery or observation. The patient then underwent an ultrasound examination performed by a staff radiologist. On the basis of the ultrasound findings the patient was placed into one of three categories: appendicitis, normal examination results, or other conditions. Patients with an ultrasound-based diagnosis of appendicitis proceeded to the operation, regardless of the surgeon's clinical impression. Those with other conditions diagnosed with ultrasonography were treated as was appropriate for the condition.
The ultrasound-derived diagnosis of appendicitis had a sensitivity of 85.5%, a specificity of 84.4%, a positive predictive value of 88.3%, a negative predictive value of 80.1%, and an overall accuracy of 85.0%. The surgeon's clinical impression at the time of admission had a sensitivity of 62.9%, a specificity of 82.2%, a positive predictive value of 82.9%, a negative predictive value of 61.7%, and an overall accuracy of 71.2%.
The overall accuracy of ultrasonography in the diagnosis of appendicitis was statistically superior to that of the surgeon's clinical impression (P < .0001). However, 24% of the patients with normal ultrasound findings were ultimately found to have appendicitis at operation, emphasizing the point that ultrasonography cannot be relied on to the exclusion of the surgeon's careful and repeated evaluation.
比较外科医生对急性阑尾炎的临床诊断准确性与腹部超声检查的准确性。
前瞻性试验。
加利福尼亚州圣地亚哥的美国海军医院。
1990年5月至1992年6月因疑似阑尾炎入院的110例患者。
记录每位患者的症状和体征，以及外科医生对立即手术或观察的临床印象。然后患者接受由放射科工作人员进行的超声检查。根据超声检查结果，将患者分为三类之一：阑尾炎、检查结果正常或其他情况。基于超声诊断为阑尾炎的患者，无论外科医生的临床印象如何，均进行手术。超声诊断为其他情况的患者则根据病情进行适当治疗。
超声诊断阑尾炎的敏感性为85.5%，特异性为84.4%，阳性预测值为88.3%，阴性预测值为80.1%，总体准确率为85.0%。入院时外科医生的临床印象敏感性为62.9%，特异性为82.2%，阳性预测值为82.9%，阴性预测值为61.7%，总体准确率为71.2%。
超声检查在阑尾炎诊断中的总体准确性在统计学上优于外科医生的临床印象（P <.0001）。然而，24%超声检查结果正常的患者最终在手术中被发现患有阑尾炎，这强调了不能仅依靠超声检查而排除外科医生仔细和反复评估的这一点。
