背景:急性阑尾炎(AA)的及时诊断对于优化腹痛急诊表现至关重要。改进的诊断程序应尽量减少复杂阑尾炎的进展,以及减少不必要的外科手术的数量。Alvarado评分是基于临床预测值来辅助AA管理的重要工具。本研究的目的是评估Alvarado评分作为在萨摩亚资源匮乏的情况下诊断AA的工具的敏感性和特异性。
方法:首席研究者对2015年1月至2016年12月在TupuaTamaseseMeaole医院AA外科病房住院的所有患者进行了回顾性临床数据回顾设计。排除标准为阑尾脓肿和/或肿块,最终诊断为“不是急性阑尾炎”。年龄,性别,村庄,AlvaradoScore,超声扫描结果,手术管理,以组织病理学结果为主要变量输入SPSS统计软件包进行分析。
结果:在因AA入院的225例患者(2-86岁)中,67.1%(N=151)接受了阑尾切除术,其余32.9%(N=74)接受抗生素治疗。Alvarado评分(≥5)对AA的敏感性为91.7%,特异性为50%。Alvarado评分与AA的超声扫描之间存在显着关系(p<0.05)。组织学结果显示68.6%(N=94)的病例为复杂AA。阑尾切除术阴性率为2.6%。
结论:在我们的萨摩亚背景下,Alvarado评分是及时鉴别诊断AA的有效工具。复杂的急性阑尾炎的高发率值得调查,以进一步改善太平洋岛屿地区的AA管理。
BACKGROUND: Timely diagnosis of acute appendicitis (AA) is essential for optimal management of abdominal pain emergency presentations. Improved diagnostic procedures should minimise progression to complicated appendicitis, as well as reduce the number of unwanted surgical interventions. The Alvarado Score is an important tool to assist with the management of AA based on clinically predictive values. The aim of the present study was to evaluate the sensitivity and specificity of the Alvarado Score as an instrument for the diagnosis of AA in our low-resourced context of Samoa.
METHODS: The lead investigator performed a retrospective clinical data review design of all patients admitted to the Tupua Tamasese Meaole Hospital Surgical Unit for AA from January 2015 to December 2016. Exclusion criteria were appendiceal abscess and/or mass, and final diagnosis \'not acute appendicitis\'. Age, sex, village, Alvarado Score, Ultrasound Scan Result, surgical management, and histopathology result were the main variables entered into the SPSS statistical software package for analysis.
RESULTS: Of the 225 patients (2-86 years) admitted for AA, 67.1% (N = 151) underwent appendicectomy, and the remaining 32.9% (N = 74) were treated with antibiotics. An Alvarado Score (≥5) showed 91.7% sensitivity and 50% specificity for AA. There was a significant relationship between the Alvarado Score and the Ultrasound Scan for AA (p < 0.05). Histology results showed complicated AA in 68.6% (N = 94) of cases. The negative appendicectomy rate was 2.6%.
CONCLUSIONS: The Alvarado Score is an effective tool for the timely differential diagnosis of AA in our Samoan context. The high rate of complicated acute appendicitis warrants investigation to further improve the management of AA in the Pacific Island setting.