PDF(Pubmed)
Abstract：
Objectives-The objective was to compare the effectiveness of observation in standard-of-care computed tomography (CT) in adult patients with suspected acute appendicitis (AA). Methods-Patients with clinically suspected AA and inconclusive diagnosis after primary clinical examination, laboratory examination, and transabdominal ultrasound (TUS) were eligible for the study, and they were randomized (1:1) to parallel groups: observation-group patients were observed for 8-12 h and then, repeated clinical and laboratory examinations and TUS were performed; CT group (control group) patients underwent abdominopelvic CT scan. The study utilized Statistical Analysis System 9.2 for data analysis, including tests, logistic regression, ROC analysis, and significance evaluation. Patients were enrolled in the study at Vilnius University Hospital Santaros Klinikos in Lithuania between December 2018 and June 2021. Results-A total of 160 patients (59 men, 101 women), with a mean age of 33.7 ± 14.71, were included, with 80 patients in each group. Observation resulted in a reduced likelihood of a CT scan compared with the CT group (36.3% vs. 100% p < 0.05). One diagnostic laparoscopy was performed in the observation group; there were no cases of negative appendectomy (NA) in the CT group. Both conditional CT and observation pathways resulted in high sensitivity and specificity (97.7% and 94.6% vs. 96.7% and 95.8%). Conclusions-Observation including the repeated evaluation of laboratory results and TUS significantly reduces the number of CT scans without increasing NA numbers or the number of complicated cases.
摘要：
目标-目的是比较在疑似急性阑尾炎（AA）的成年患者中进行标准护理计算机断层扫描（CT）观察的有效性。方法-临床怀疑AA，经初步临床检查诊断不明确的患者，实验室检查,经腹超声（TUS）符合研究条件，他们被随机(1:1)分为平行组:观察组患者观察8-12小时，然后，重复进行临床和实验室检查和TUS；CT组（对照组）患者接受腹盆腔CT扫描。本研究利用统计分析系统9.2进行数据分析，包括测试,逻辑回归，ROC分析,和意义评价。患者于2018年12月至2021年6月在立陶宛维尔纽斯大学医院SantarosKlinikos进行了研究。结果-共有160例患者(59例男性，101名妇女），平均年龄为33.7±14.71岁，每组80例。与CT组相比，观察导致CT扫描的可能性降低(36.3%vs.100%p<0.05)。观察组行1例诊断性腹腔镜检查;CT组无1例阑尾切除术(NA)阴性。条件CT和观察途径均具有较高的敏感性和特异性（97.7%和94.6%vs.96.7%和95.8%）。结论-包括实验室结果的重复评估和TUS的观察显着减少了CT扫描的数量，而不增加NA数量或复杂病例的数量。
