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Abstract：
BACKGROUND: Acute appendicitis (AA) is one of the most common reasons for visiting the emergency room. The lack of proper diagnosis and rapid treatment of AA may lead to severe complications such as intestinal perforation and increased mortality. This study aimed to evaluate the diagnostic accuracy of the Alvarado criteria, ultrasound, and CRP criteria in comparison with their combined use in patients with suspected AA who presented to the emergency room.
METHODS: In this diagnostic accuracy study, 1411 patients with suspected AA who presented to the emergency department of Firoozabadi Hospital affiliated with Iran University of Medical Sciences and underwent appendectomy from October 2019 to October 2021 were examined. Nine hundred eighty-eight patients were enrolled. All patients were assessed using Alvarado, CRP, and ultrasound. The definitive diagnosis of AA was based on pathological findings and was considered the gold standard. Statistical analyses were performed with STATA VER 11.5. The diagnostic accuracy for each group was compared using the Pearson chi-square test. A value of p < 0.05 was considered statistically significant.
RESULTS: The mean age was 29.57 ± 13.66 years. The sensitivity and specificity of Alvarado in the diagnostic accuracy of appendicectomy were 75.2% and 61.3% (CI = 95%), respectively. The sensitivity of ultrasound and CRP for predicting appendicitis was significantly higher than the Alvarado criteria. The diagnostic accuracy for CRP was significantly higher than ultrasound (64.9% vs. 60.7%, P: 0.003). The diagnostic accuracy of the simultaneous use of Alvarado + CRP and CRP + Ultrasound was significantly higher than that of Alvarado + ultrasound. The sensitivity, specificity, and diagnostic accuracy of the simultaneous use of all three criteria together (Alvarado + Ultrasound + CRP) were estimated to be 94.9%, 25.8%, and 81.5% (CI = 95%), respectively, which were significantly higher than the use of other criteria.
CONCLUSIONS: This study showed that the Alvarado criteria had inadequate diagnostic sensitivity and accuracy for diagnosing acute appendicitis. The diagnostic accuracy of acute appendicitis increases to over 90% using the three Alvarado, ultrasound, and CRP criteria at the same time.
METHODS: In this diagnostic accuracy study, 1411 patients with suspected AA who presented to the emergency department of Firoozabadi Hospital affiliated with Iran University of Medical Sciences and underwent appendectomy from October 2019 to October 2021 were examined. Nine hundred eighty-eight patients were enrolled. All patients were assessed using Alvarado, CRP, and ultrasound. The definitive diagnosis of AA was based on pathological findings and was considered the gold standard. Statistical analyses were performed with STATA VER 11.5. The diagnostic accuracy for each group was compared using the Pearson chi-square test. A value of p < 0.05 was considered statistically significant.
RESULTS: The mean age was 29.57 ± 13.66 years. The sensitivity and specificity of Alvarado in the diagnostic accuracy of appendicectomy were 75.2% and 61.3% (CI = 95%), respectively. The sensitivity of ultrasound and CRP for predicting appendicitis was significantly higher than the Alvarado criteria. The diagnostic accuracy for CRP was significantly higher than ultrasound (64.9% vs. 60.7%, P: 0.003). The diagnostic accuracy of the simultaneous use of Alvarado + CRP and CRP + Ultrasound was significantly higher than that of Alvarado + ultrasound. The sensitivity, specificity, and diagnostic accuracy of the simultaneous use of all three criteria together (Alvarado + Ultrasound + CRP) were estimated to be 94.9%, 25.8%, and 81.5% (CI = 95%), respectively, which were significantly higher than the use of other criteria.
CONCLUSIONS: This study showed that the Alvarado criteria had inadequate diagnostic sensitivity and accuracy for diagnosing acute appendicitis. The diagnostic accuracy of acute appendicitis increases to over 90% using the three Alvarado, ultrasound, and CRP criteria at the same time.
摘要：
背景：急性阑尾炎（AA）是前往急诊室的最常见原因之一。缺乏正确的诊断和快速治疗可能导致严重的并发症，如肠穿孔和死亡率增加。本研究旨在评估阿尔瓦拉多标准的诊断准确性，超声，和CRP标准，并将其与在急诊室就诊的疑似AA患者中的联合使用进行比较。
方法：在这项诊断准确性研究中，从2019年10月至2021年10月，到伊朗医科大学附属Firoozabadi医院急诊科就诊并接受阑尾切除术的1411例疑似AA患者进行检查。招募了988名患者。所有患者均使用Alvarado进行评估，CRP,和超声波。AA的最终诊断是基于病理结果，并被认为是金标准。用STATAVER11.5进行统计分析。使用Pearson卡方检验比较各组的诊断准确性。p<0.05的值被认为是统计学上显著的。
结果：平均年龄为29.57±13.66岁。Alvarado对阑尾切除术诊断准确率的敏感性和特异性分别为75.2%和61.3%(CI=95%),分别。超声和CRP预测阑尾炎的敏感性明显高于Alvarado标准。CRP的诊断准确率明显高于超声（64.9%vs.60.7%,P:0.003)。同时使用Alvarado+CRP和CRP+超声的诊断准确率明显高于Alvarado+超声。敏感性,特异性，同时使用所有三个标准（Alvarado超声CRP）的诊断准确性估计为94.9％，25.8%,和81.5%（CI=95%），分别,显着高于其他标准的使用。
结论：本研究表明，Alvarado标准诊断急性阑尾炎的敏感性和准确性不足。使用三种Alvarado，急性阑尾炎的诊断准确性提高到90％以上，超声，和CRP标准在同一时间。
方法：在这项诊断准确性研究中，从2019年10月至2021年10月，到伊朗医科大学附属Firoozabadi医院急诊科就诊并接受阑尾切除术的1411例疑似AA患者进行检查。招募了988名患者。所有患者均使用Alvarado进行评估，CRP,和超声波。AA的最终诊断是基于病理结果，并被认为是金标准。用STATAVER11.5进行统计分析。使用Pearson卡方检验比较各组的诊断准确性。p<0.05的值被认为是统计学上显著的。
结果：平均年龄为29.57±13.66岁。Alvarado对阑尾切除术诊断准确率的敏感性和特异性分别为75.2%和61.3%(CI=95%),分别。超声和CRP预测阑尾炎的敏感性明显高于Alvarado标准。CRP的诊断准确率明显高于超声（64.9%vs.60.7%,P:0.003)。同时使用Alvarado+CRP和CRP+超声的诊断准确率明显高于Alvarado+超声。敏感性,特异性，同时使用所有三个标准（Alvarado超声CRP）的诊断准确性估计为94.9％，25.8%,和81.5%（CI=95%），分别,显着高于其他标准的使用。
结论：本研究表明，Alvarado标准诊断急性阑尾炎的敏感性和准确性不足。使用三种Alvarado，急性阑尾炎的诊断准确性提高到90％以上，超声，和CRP标准在同一时间。
