Abstract：
Controversies remain on the diagnostic strategy in suspected AA, considering the different settings worldwide.
A prospective observational international multicentric study including patients operated for suspected AA with a definitive histopathological analysis was conducted. Three groups were analyzed: (1) No radiology; (2) Ultrasound, and (3) Computed tomography. The aim was to analyze the performance of three diagnostic schemes.
Three thousand and one hundred twenty three patients were enrolled; 899 in the no radiology group, 1490 in the US group, and 734 in the CT group. The sex ratio was in favor of males (p < 0.001). The mean age was lower in the no radiology group (24 years) compared to 28 and 38 years in US and CT-scan groups, respectively (p < 0.001). Overall, the negative appendectomy rate 3.8%: no radiology group (5.1%) versus US (2.9%) and CT-scan (4.1%) (p < 0.001). The sensitivity and specificity analysis showed the best balance in clinical evaluation + score + US. These data reach the best results in those patients with an equivocal Alvarado score (4-6). Inverse probability weighting (IPW), showed as the use of ultrasound, is significantly associated with an increased probability of formulating the correct diagnosis (p 0.004). In the case of a CT scan, this association appears weaker (p 0.08).
The association of clinical scores and ultrasound seems the best strategy to reach a correct preoperative diagnosis in patients with clinical suspicion of AA, even in those population subgroups where the clinical score may have an equivocal result. This strategy can be especially useful in low-resource settings worldwide. CT-scan association may improve the detection of patients who may potentially be submitted to conservative treatment.
A prospective observational international multicentric study including patients operated for suspected AA with a definitive histopathological analysis was conducted. Three groups were analyzed: (1) No radiology; (2) Ultrasound, and (3) Computed tomography. The aim was to analyze the performance of three diagnostic schemes.
Three thousand and one hundred twenty three patients were enrolled; 899 in the no radiology group, 1490 in the US group, and 734 in the CT group. The sex ratio was in favor of males (p < 0.001). The mean age was lower in the no radiology group (24 years) compared to 28 and 38 years in US and CT-scan groups, respectively (p < 0.001). Overall, the negative appendectomy rate 3.8%: no radiology group (5.1%) versus US (2.9%) and CT-scan (4.1%) (p < 0.001). The sensitivity and specificity analysis showed the best balance in clinical evaluation + score + US. These data reach the best results in those patients with an equivocal Alvarado score (4-6). Inverse probability weighting (IPW), showed as the use of ultrasound, is significantly associated with an increased probability of formulating the correct diagnosis (p 0.004). In the case of a CT scan, this association appears weaker (p 0.08).
The association of clinical scores and ultrasound seems the best strategy to reach a correct preoperative diagnosis in patients with clinical suspicion of AA, even in those population subgroups where the clinical score may have an equivocal result. This strategy can be especially useful in low-resource settings worldwide. CT-scan association may improve the detection of patients who may potentially be submitted to conservative treatment.
摘要：
背景：怀疑AA的诊断策略仍然存在争议，考虑到全球不同的环境。
方法：进行了一项前瞻性观察性国际多中心研究，包括疑似AA患者，并进行了明确的组织病理学分析。三组进行分析：（1）无放射学；（2）超声，和（3）计算机断层扫描。目的是分析三种诊断方案的性能。
结果：纳入了三千一百二十三例患者；无放射学组899例，1490在美国集团，CT组734。性别比对男性有利(p<0.001)。无放射学组（24岁）的平均年龄低于美国和CT扫描组的28岁和38岁，分别(p<0.001)。总的来说,阴性阑尾切除术率为3.8%:无放射学组(5.1%)与美国(2.9%)和CT扫描(4.1%)(p<0.001).敏感性和特异性分析显示，临床评估+评分+US平衡最好。这些数据在那些具有模棱两可的Alvarado评分（4-6）的患者中达到最佳结果。逆概率加权(IPW)，显示为使用超声波，与制定正确诊断的可能性增加显著相关(p0.004)。在CT扫描的情况下,这种联系似乎较弱(p0.08)。
结论：临床评分与超声的关联似乎是临床怀疑AA患者术前正确诊断的最佳策略，即使在临床评分可能有模棱两可的结果的人群亚组中.此策略在全球资源匮乏的环境中尤其有用。CT扫描关联可以改善对可能接受保守治疗的患者的检测。
方法：进行了一项前瞻性观察性国际多中心研究，包括疑似AA患者，并进行了明确的组织病理学分析。三组进行分析：（1）无放射学；（2）超声，和（3）计算机断层扫描。目的是分析三种诊断方案的性能。
结果：纳入了三千一百二十三例患者；无放射学组899例，1490在美国集团，CT组734。性别比对男性有利(p<0.001)。无放射学组（24岁）的平均年龄低于美国和CT扫描组的28岁和38岁，分别(p<0.001)。总的来说,阴性阑尾切除术率为3.8%:无放射学组(5.1%)与美国(2.9%)和CT扫描(4.1%)(p<0.001).敏感性和特异性分析显示，临床评估+评分+US平衡最好。这些数据在那些具有模棱两可的Alvarado评分（4-6）的患者中达到最佳结果。逆概率加权(IPW)，显示为使用超声波，与制定正确诊断的可能性增加显著相关(p0.004)。在CT扫描的情况下,这种联系似乎较弱(p0.08)。
结论：临床评分与超声的关联似乎是临床怀疑AA患者术前正确诊断的最佳策略，即使在临床评分可能有模棱两可的结果的人群亚组中.此策略在全球资源匮乏的环境中尤其有用。CT扫描关联可以改善对可能接受保守治疗的患者的检测。
