Alvarado评分对儿科医生诊断急性阑尾炎有帮助吗?我们的中心体验

IF 0.5 Q4 PEDIATRICS
Sedigheh Rafiei Tabatabaei, A. Karimi, M. Nassiri, L. Mohajerzadeh, S. Armin, Roxana Mansour Ghanaie, S. Fahimzad, F. Shiva, F. Fallah, A. Shamshiri, I. Sedighi, S. Sayyahfar, M. S. Rezai, B. Abdinia, Hosein Heydari, Gholamreza Soleimani, Mostafa Behpour Oskouee, Jafar Soltani, M. Ahmadi, M. Kahbazi, Sayeh Hatefi
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引用次数: 1

摘要

背景:在疑似阑尾炎患者的诊断中存在许多问题,导致了临床评分系统的设计。对于儿童,阑尾炎的诊断工具更为关键。患者年龄越小,诊断难度越大。实用的评分系统是有用的,没有任何特殊的材料和必要的新颖的能力。目的:然而,尽管报道了显著的后果,这些评分系统并没有被经常使用。方法:在2016年10月至2017年10月的横断面研究中,从伊朗31个省份中随机抽取10个省份。对631例疑似急性阑尾炎的转诊患者进行了评估。相关变量,如年龄、性别、右下腹(RLQ)疼痛、疼痛向RLQ的转移、恶心、呕吐、厌食、RLQ的压痛和保护、反跳压痛的存在和发烧程度,均由儿科医生从记录文件中提取。采用Alvarado评分系统对纳入的病例进行评估,以评估本中心阑尾炎诊断的准确性。结果:符合条件的患者平均年龄9.3±3.21岁,年龄3 ~ 18岁,男性380例(60.5%)。本研究采用Alvarado评分系统,考虑7分的临界值决定手术,阳性预测值(PPV)为32.6%,阴性预测值(NPV)为76.73%,敏感性为44.05%,特异性为66.95%。Alvarado评分与AA诊断无统计学意义(P < 0.05)。在受试者操作者特征曲线(ROC)方面,阿尔瓦拉多的曲线下面积(AUC)为0.58(0.54 ~ 0.63)。AUC很低,对阑尾炎的诊断无价值。根据本研究结果,建议将4.5分作为儿童急性阑尾炎诊断的分界点,敏感性为73%,特异性为58%。结论:虽然Alvarado评分为诊断小儿阑尾炎提供了明显实用的诊断信息,但该方法在临床实践中没有提供足够的PPV作为确定必要手术的安全方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is Alvarado Score Helpful for Pediatrician in Diagnosis of Acute Appendicitis? Our Center Experience
Background: Many problems in the diagnosis of patients with suspected appendicitis have led to the design of clinical scoring systems. In children, diagnostics tools for appendicitis are more critical. Younger patients, diagnostic challenges become more. Practical scoring systems are useful without any particular material and necessitate novel ability. Objectives: However, in spite of the reported outstanding consequences, these scoring systems are not employed regularly. Methods: In this cross-sectional study performed from October 2016 to October 2017, ten provinces out of the 31 provinces in Iran were randomly selected. A total of 631 patients referring to the hospitals with the suspicion of acute appendicitis were assessed. Related variables such as age, sex, right lower quadrant (RLQ) pain, migration of pain to RLQ, nausea, and presence of vomiting, anorexia, tenderness in RLQ and guarding, presence of rebound tenderness, and degree of fever were taken from recorded files by pediatricians. Alvarado scoring system was used for included cases to assess the accuracy of this test for diagnosis of appendicitis in our centers. Results: The mean age of eligible patients was 9.3 ± 3.21 years ranged from 3 years to 18 years, and 380 (60.5%) were male. Using the Alvarado score system in this study, considering the cut-off point value of 7 to decide for operation, the positive predictive value (PPV) showed 32.6%, and negative predictive value (NPV) was 76.73%, with a sensitivity of 44.05% and, specificity of 66.95%. There were statistically no significant correlations among the scoring of the Alvarado and diagnosis of AA (P < 0.05). Regarding receiver operator characteristic curves (ROC), the area under curve (AUC) was 0.58 (0.54 to 0.63) for Alvarado. The AUC was very low, so there was no value for the diagnosis of appendicitis. According to the findings of the present study, the cut-off point of 4.5 is suggested for the diagnosis of acute appendicitis in children with a sensitivity of 73% and specificity of 58%. Conclusions: Although the Alvarado scores supply obviously practical diagnostic information in the management of pediatric population with supposed appendicitis, this method delivers no adequate PPV for clinical practice as a safe way for determining necessary operation.
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来源期刊
CiteScore
1.80
自引率
14.30%
发文量
22
期刊介绍: Archives Of Pediatric Infectious Disease is a clinical journal which is informative to all practitioners like pediatric infectious disease specialists and internists. This authoritative clinical journal was founded by Professor Abdollah Karimi in 2012. The Journal context is devoted to the particular compilation of the latest worldwide and interdisciplinary approach and findings including original manuscripts, meta-analyses and reviews, health economic papers, debates and consensus statements of clinical relevance to pediatric disease field, especially infectious diseases. In addition, consensus evidential reports not only highlight the new observations, original research and results accompanied by innovative treatments and all the other relevant topics but also include highlighting disease mechanisms or important clinical observations and letters on articles published in the journal.
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