评估成人阑尾炎风险预测模型的全国性前瞻性审计:右髂窝治疗(RIFT)-土耳其。

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-09-03 DOI:10.1093/bjsopen/zrae120
Ali Yalcinkaya, Ahmet Yalcinkaya, Bengi Balci, Can Keskin, Ibrahim Erkan, Alp Yildiz, Erdinc Kamer, Sezai Leventoglu
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引用次数: 0

摘要

背景:阑尾炎是最常见的外科急症:阑尾炎是最常见的外科急症。阑尾切除术的阴性率和诊断的不确定性是人们关注的重要问题。本研究旨在评估当前阑尾炎风险预测模型在急性右髂窝疼痛患者中的有效性:方法:开展了一项全国性的前瞻性观察研究,包括所有连续出现右髂窝疼痛的成年患者。记录诊断、临床和阑尾切除阴性率数据。根据收集的数据计算出阿尔瓦拉多评分、阑尾炎炎症反应(AIR)、Raja Isteri Pengiran Anak Saleha Appendicitis(RIPASA)和成人阑尾炎评分系统,将患者分为不同的风险类别。通过使用基于风险类别的指标,包括 "真阳性率"(最高风险类别中阑尾炎患者的百分比)、"失败率"(最低风险类别中阑尾炎患者的百分比)和 "分类分辨率"(真阳性率/失败率),对诊断价值和分类性能进行了评估:结果:共纳入了来自 84 个中心的 3358 名患者。女性患者接受手术的可能性低于男性(分别为71.5%对82.5%;相对风险0.866,95% c.i.0.834至0.901,P <0.001);阑尾切除术的阴性率高三倍(分别为11.3%对4.1%;相对风险2.744,95% c.i.2.047至3.677,P <0.001)。56.8%的患者使用了超声波检查,75.2%的患者使用了计算机断层扫描。在所有人群中,成人阑尾炎评分的诊断效果最好;然而,只有 RIPASA 对男性有显著意义。所有评分系统对女性患者的诊断都很成功,但成人阑尾炎评分的接收者操作特征曲线下面积值最高。RIPASA 和成人阑尾炎评分具有最佳的分类分辨率值,而且在男性和女性患者中的失败率都非常低。Alvarado和AIR在男性患者中的失败率极高:结论:阑尾切除术的阴性率总体较低,但女性尽管接受手术的可能性较低,但阑尾切除术的阴性率却高出近三倍。过度使用影像检查可能会导致成本增加,接受计算机断层扫描的患者比例高达 75.2%,就是最好的例证。RIPASA和成人阑尾炎评分等风险评分系统似乎优于Alvarado和AIR。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Nationwide prospective audit for the evaluation of appendicitis risk prediction models in adults: right iliac fossa treatment (RIFT)-Turkey.

Background: Appendicitis is the most prevalent surgical emergency. The negative appendicectomy rate and diagnostic uncertainty are important concerns. This study aimed to assess the effectiveness of current appendicitis risk prediction models in patients with acute right iliac fossa pain.

Methods: A nationwide prospective observational study was conducted, including all consecutive adult patients who presented with right iliac fossa pain. Diagnostic, clinical and negative appendicectomy rate data were recorded. The Alvarado score, Appendicitis Inflammatory Response (AIR), Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Adult Appendicitis Score systems were calculated with collected data to classify patients into risk categories. Diagnostic value and categorization performance were evaluated, with use of risk category-based metrics including 'true positive rate' (percentage of appendicitis patients in the highest risk category), 'failure rate' (percentage of patients with appendicitis in the lowest risk category) and 'categorization resolution' (true positive rate/failure rate).

Results: A total of 3358 patients from 84 centres were included. Female patients were less likely to undergo surgery than men (71.5% versus 82.5% respectively; relative risk 0.866, 95% c.i. 0.834 to 0.901, P < 0.001); with a three-fold higher negative appendicectomy rate (11.3% versus 4.1% respectively; relative risk 2.744, 95% c.i. 2.047 to 3.677, P < 0.001). Ultrasonography was utilized in 56.8% and computed tomography in 75.2% of all patients. The Adult Appendicitis Score had the best diagnostic performance for the whole population; however, only RIPASA was significant in men. All scoring systems were successful in females patients, but Adult Appendicitis Score had the highest area under the receiver operating characteristic curve value. The RIPASA and the Adult Appendicitis Score had the best categorization resolution values, complemented by their exceedingly low failure rates in both male and female patients. Alvarado and AIR had extremely high failure rates in men.

Conclusion: The negative appendicectomy rate was low overall, but women had an almost three-fold higher negative appendicectomy rate despite lower likelihood to undergo surgery. The overuse of imaging tests, best exemplified by the 75.2% frequency of patients undergoing computed tomography, may lead to increased costs. Risk-scoring systems such as RIPASA and Adult Appendicitis Score appear to be superior to Alvarado and AIR.

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BJS Open
BJS Open SURGERY-
CiteScore
6.00
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3.20%
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