Fenyö G, Lindberg G, Blind P, Enochsson L, Oberg A
Department of Surgery, Nacka Hospital, Stockholm, Sweden.
Eur J Surg. 1997 Nov;163(11):831-8.
To validate a simplified scoring system as an aid to the diagnosis of acute appendicitis.
Open prospective study.
County district hospital, and university hospital, Sweden.
1167 Patients with suspected appendicitis.
Correlation between scoring system and final diagnosis.
A total of 475 patients were operated on and 392 (82.5%) of these had histologically verified appendicitis. The negative laparotomy rate was 17.5% (11.2% for men and 25.4% for women). The sensitivity of the scoring system for appendicitis at the main cut-off point (score -2 or more) was 0.73 and the specificity was 0.87. At the cut-off level (score - 17 or less) for predicting non-specific abdominal pain (NSAP) the proportion of correctly classified patients was 0.72 and the proportion of false negatives (patients with appendicitis classified as NSAP) was 0.14. Analysis of the area under the receiver operating characteristic (ROC) curve showed that the scoring system performed slightly worse in the university hospital (area 0.83) than in the district hospital where it was originally developed (area 0.89).
The scoring system was a valid instrument for discriminating between acute appendicitis and NSAP in the two centres studied. Use of the scoring system in daily clinical work was associated with a reduced rate of negative laparotomies.
验证一种简化评分系统，以辅助急性阑尾炎的诊断。
开放性前瞻性研究。
瑞典的县级医院和大学医院。
1167例疑似阑尾炎患者。
评分系统与最终诊断之间的相关性。
共有475例患者接受了手术，其中392例（82.5%）经组织学证实为阑尾炎。阴性剖腹率为17.5%（男性为11.2%，女性为25.4%）。评分系统在主要分界点（评分-2或更高）时对阑尾炎的敏感性为0.73，特异性为0.87。在预测非特异性腹痛（NSAP）的分界水平（评分-17或更低）时，正确分类患者的比例为0.72，假阴性比例（阑尾炎被分类为NSAP的患者）为0.14。对受试者工作特征（ROC）曲线下面积的分析表明，评分系统在大学医院（面积0.83）的表现略逊于其最初研发的地区医院（面积0.89）。
在本研究的两个中心，评分系统是区分急性阑尾炎和NSAP的有效工具。在日常临床工作中使用评分系统与阴性剖腹率降低相关。
