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Abstract：
Background The clinical diagnosis of acute appendicitis (AA) can be challenging. This study aimed to evaluate the significance of this diagnosis amidst technological progress. It compared clinical diagnosis to radiology-aided diagnostic outcomes and negative appendicectomy rates (NAR). Methodology This study conducted a single-center retrospective and prospective cohort observational study on all adult patients presenting with suspected AA in 2018 at a major tertiary teaching hospital in Perth, Western Australia. Key demographics, clinicopathological, radiology, and operative reports were reviewed. Data were analyzed using SPSS v.27. Results Of 418 patients with suspected AA, 234 (56%) were in the retrospective group. The median age was 35 (IQR=26), and 224 (54%) were female. The overall NAR was 18.6% (95% CI (14.8-22.4)) and 20.8% for clinical diagnosis. Notably, the NAR for ultrasound (USS)-reported AA (false positive) was 17.6% (95% CI (10.6-27.4)). Three-quarters of the patients, 298 (71.3%), had radiological imaging. The most common modality was CT 176 (59.1%), and 33 (7.9%) had both CT and USS imaging performed. Compared with final histopathology, no significant difference was found in the accuracy of clinically diagnosed and USS-diagnosed cases, with rates of 83.5% and 82.5%, respectively (p=0.230). CT had the best positive predictive value at 82.1%. Single-modality imaging did not cause a significant surgical delay (p=0.914), but multi-modal imaging showed a non-significant trend toward delay (p=0.065). When surgeons assessed an appendix as normal, 54 (12.9%), the histopathological assessment revealed pathology in 28 (51.9%). The inter-observer agreement was only fair to moderate, Kappa=0.46 (95% CI (0.33-0.58); p<0.001). The intraoperative identification of a normal appendix inversely correlated to the grade of the primary surgeon, which was likely related to the number of surgical personnel in the theater (p<0.001). Conclusion This study showed that clinical diagnosis matches the diagnostic accuracy of imaging technologies. Utilizing diagnostic imaging methods promptly and appropriately did not lead to considerable delays in surgery. Surgeons\' capability to diagnose appendicitis during surgery is moderately accurate. Most patients underwent imaging, with CT scans being the most common. Moving forward, practitioners must minimize excessive reliance on imaging techniques as this can be resource-intensive, especially in developing countries. Future clinical practice should balance embracing technological advancements and preserving essential clinical diagnostic expertise, for medicine is both a science and an art.
摘要：
背景急性阑尾炎（AA）的临床诊断可能具有挑战性。本研究旨在评估该诊断在技术进步中的意义。它比较了临床诊断与放射学辅助诊断结果和阴性阑尾切除术率（NAR）。方法本研究对珀斯一家主要三级教学医院2018年所有疑似AA的成年患者进行了单中心回顾性和前瞻性队列观察研究，西澳大利亚。关键人口统计，临床病理,放射学,和手术报告进行了审查。数据采用SPSSv.27进行分析。结果418例疑似AA患者中,回顾性组234例（56%）。中位年龄为35岁（IQR=26），224人(54%)为女性。总体NAR为18.6%(95%CI(14.8-22.4)),临床诊断为20.8%。值得注意的是,超声（USS）报告的AA（假阳性）的NAR为17.6％（95％CI（10.6-27.4））。四分之三的病人,298（71.3%），有放射成像。最常见的模态是CT176（59.1％），33例(7.9%)同时进行了CT和USS成像.与最终的组织病理学相比，临床诊断和USS诊断病例的准确性没有发现显着差异，率分别为83.5%和82.5%，分别(p=0.230)。CT阳性预测值最好，为82.1%。单模态成像没有引起明显的手术延迟（p=0.914），但多模态成像显示无明显延迟趋势(p=0.065).当外科医生评估阑尾正常时，54（12.9%），组织病理学评估显示28例(51.9%)有病理.观察员之间的协议只是公平的，Kappa=0.46（95%CI（0.33-0.58）；p<0.001）。正常阑尾的术中鉴定与主刀外科医生的等级成反比。这可能与手术室的手术人数有关（p<0.001）。结论本研究表明，临床诊断与影像学技术的诊断准确性相匹配。及时和适当地使用诊断成像方法不会导致手术的相当大的延迟。外科医生在手术过程中诊断阑尾炎的能力中等准确。大多数患者接受了影像学检查，CT扫描是最常见的。往前走,从业者必须尽量减少对成像技术的过度依赖，因为这可能是资源密集型的，尤其是在发展中国家。未来的临床实践应该平衡拥抱技术进步和保留必要的临床诊断专业知识。医学既是一门科学，也是一门艺术。
