Singer A J, McCracken G, Henry M C, Thode H C, Cabahug C J
Department of Emergency Medicine, University Medical Center, State University of New York at Stony Brook, USA.
Ann Emerg Med. 1996 Sep;28(3):267-72. doi: 10.1016/s0196-0644(96)70024-0.
To assess the ability of various clinical and laboratory parameters to predict the results of hepatobiliary scintigraphy (HBS) in patients with suspected acute cholecystitis.
This was a retrospective chart review of all patients referred from the emergency department for an HBS in 1993 to exclude acute cholecystitis. The setting was a university-affiliated tertiary care hospital with an annual census of approximately 42,000. The participants were 100 consecutive patients who were seen in the ED and had an HBS and obtainable medical records. Medical records of all patients referred from the ED for an urgent HBS in 1993 were retrospectively reviewed for the following information: demographics, historical information, physical findings, laboratory findings, biliary scintigraphic findings, and surgical pathologic findings. Comparisons were made between patients with a positive or negative HBS. Sensitivities, specificities, and positive and negative predictive values were calculated for dichotomous variables with a positive HBS as a control standard. A separate analysis was performed for patients with pathologically confirmed acute cholecystitis.
Fifty-three patients had a positive HBS, and 47 had a negative HBS. A history of fever had a positive predictive value of 100% and a sensitivity of 14.6%. The presence of Murphy's sign was both sensitive (97.2%) and highly predictive (93.3%) of a positive HBS yet was not documented in 35 cases. All other variables were not found to be helpful in predicting the results of HBS. Pathologic diagnoses were available in 44 patients. Of 40 patients with pathologically confirmed acute cholecystitis, fever and leukocytosis were absent at the time of presentation in 36 (90%) and 16 (40%) of the cases, respectively. Murphy's sign was absent in 3 (10%) of 29 of these patients. A stepwise analysis failed to identify any combination of clinical variables that was associated with a higher probability of a positive HBS.
No single or combination of clinical or laboratory findings at the time of ED presentation identified all patients with a positive HBS. Murphy's sign had the highest sensitivity and positive predictive value yet was poorly documented. Liberal use of biliary scintigraphy or ultrasound is encouraged to avoid underdiagnosis of acute cholecystitis.
评估各种临床和实验室参数对疑似急性胆囊炎患者肝胆闪烁显像（HBS）结果的预测能力。
这是一项对1993年从急诊科转诊进行HBS以排除急性胆囊炎的所有患者的回顾性病历审查。研究地点是一家大学附属的三级护理医院，年普查人数约为42000人。研究对象为100例连续在急诊科就诊并接受了HBS检查且有可获取病历的患者。对1993年从急诊科转诊进行紧急HBS检查的所有患者的病历进行回顾性审查，以获取以下信息：人口统计学资料、病史信息、体格检查结果、实验室检查结果、胆道闪烁显像结果和手术病理结果。对HBS结果为阳性或阴性的患者进行比较。以HBS结果为阳性作为对照标准，计算二分变量的敏感性、特异性、阳性预测值和阴性预测值。对病理确诊为急性胆囊炎的患者进行了单独分析。
53例患者HBS结果为阳性，47例为阴性。发热史的阳性预测值为100%，敏感性为14.6%。墨菲氏征的存在对HBS结果为阳性既敏感（97.2%）又具有高度预测性（93.3%），但有35例未记录该体征。未发现其他变量有助于预测HBS结果。44例患者有病理诊断结果。在40例病理确诊为急性胆囊炎的患者中，分别有36例（90%）和16例（40%）在就诊时无发热和白细胞增多。在这些患者中的29例中有3例（10%）无墨菲氏征。逐步分析未能确定任何与HBS结果为阳性可能性较高相关的临床变量组合。
在急诊科就诊时，没有单一的或临床及实验室检查结果的组合能够识别出所有HBS结果为阳性的患者。墨菲氏征具有最高的敏感性和阳性预测值，但记录不佳。鼓励广泛使用胆道闪烁显像或超声检查，以避免急性胆囊炎的漏诊。
