Περίληψη:
This study aimed (1) to develop a simple scoring system incorporating
ultrasound (US) examination and clinical or laboratory predictors for
increasing diagnostic accuracy in acute appendicitis (AA), and (2) to
evaluate the performance of the scoring system as compared to that of
previous models. Fifteen variables including US assessment for patients
admitted with suspected AA were considered in multivariate analysis
using the finding of AA at operation as the end point (internal study).
The new score, together with It previous ones, was applied to a
prospective independent population of subjects with suspected AA, and
the respective performances were compared (external validation study).
Among 303 patients (170 males, mean age 28.3 +/- 13.3 years) of the
internal study, 161 went on to surgery, and 130 had AA at operation.
Four independent correlates of AA were identified and used for the
derivation of the following integer-based scoring system: number of
points = 6 for US demonstrating AA + 4 for tenderness in the right lower
quadrant + 3 for rebound tenderness + 2 for leukocyte count > 12,000/mu
l. In the external study (201 subjects, 105 males, mean age 28.7 +/-
11.9 years, 109 operated, 87 with AA), when the cut-off of : 8 points
for AA was used, sensitivity, specificity, accuracy, and area under the
curve of the proposed score were 95.4%, 97.4%, 96.5%, and 93%,
respectively, exceeding noticeably the previous models. The proposed
scoring system introduces a quantitative combination of the clinical
evaluation with US imaging and a marker of inflammatory response, which
may enhance the diagnostic accuracy for subjects with suspected AA
especially in geographical areas where CT scanning is not readily
available on a 24-hour basis.
Συγγραφείς:
Tzanakis, NE
Efstathiou, SP
Danulidis, K
Rallis, GE and
Tsioulos, DI
Chatzivasiliou, A
Peros, G
Nikiteas, NI
