■虽然大多数急性胰腺炎(AP)患者符合特征性腹痛和血清脂肪酶水平至少为正常上限(参考范围)的3倍的诊断标准,早期成像通常用于确认。使用非影像学参数开发了先验预测模型和相应的基于点的评分,以诊断急诊(ED)就诊的患者的AP。
■评估预测模型在前瞻性患者队列中诊断AP的性能。
■这项前瞻性诊断研究包括2020年1月1日至2021年3月9日在美国东北部2个大型学术医疗中心就诊的连续成年患者,血清脂肪酶水平至少是正常上限的3倍。从外部机构转移或患有恶性疾病并建立腹内转移的患者,急性创伤,或改变的心理被排除。对2023年10月15日至10月23日的数据进行了分析。
■参与者被分配初始血清脂肪酶水平的分数,先前AP发作次数,先前的胆石症,2个月内进行腹部手术,上腹痛的存在,严重程度恶化的疼痛,从疼痛发作到出现的持续时间,和ED时的疼痛程度。
■AP的最终诊断,由专家审查住院记录建立。
■349名参与者的前瞻性得分(平均[SD]年龄,53.0[18.8]年;184名女性[52.7%];66名黑人[18.9%];199名白人[57.0%])显示出0.91的接受者工作特征曲线下面积。至少6分的分数达到最高准确度(F分数,82.0),对应于81.5%的灵敏度,特异性85.9%,阳性预测值为82.6%,对AP诊断的阴性预测值为85.1%。早期计算机断层扫描或磁共振成像在预测患有AP的参与者中更频繁地进行(155人中的116人[74.8%]得分≥6比194人中的111人[57.2%]得分<6;P<.001)。早期影像学显示116名参与者中有8名(6.9%)得到了替代诊断,得分至少为6分。93人中的1人(1.1%),得分至少7分,73人中有1人(1.4%),得分至少为8分。
■在这项多中心诊断研究中,预测模型显示出优异的AP诊断准确性。其应用可用于避免不必要的确认成像。
UNASSIGNED: While most patients with acute pancreatitis (AP) fulfill diagnostic criteria with characteristic abdominal pain and serum lipase levels of at least 3 times the upper limit of normal (reference range) at presentation, early imaging is often used for confirmation. A prior prediction model and corresponding point-based score were developed using nonimaging parameters to diagnose AP in patients presenting to the emergency department (ED).
UNASSIGNED: To evaluate the performance of the prediction model to diagnose AP in a prospective patient cohort.
UNASSIGNED: This prospective diagnostic study included consecutive adult patients presenting to the ED between January 1, 2020, and March 9, 2021, at 2 large academic medical centers in the northeastern US with serum lipase levels at least 3 times the upper limit of normal. Patients transferred from outside institutions or with malignant disease and established intra-abdominal metastases, acute trauma, or altered mentation were excluded. Data were analyzed from October 15 to October 23, 2023.
UNASSIGNED: Participants were assigned scores for initial serum lipase level, number of prior AP episodes, prior cholelithiasis, abdominal surgery within 2 months, presence of epigastric pain, pain of worsening severity, duration from pain onset to presentation, and pain level at ED presentation.
UNASSIGNED: A final diagnosis of AP, established by expert review of hospitalization records.
UNASSIGNED: Prospective scores in 349 participants (mean [SD] age, 53.0 [18.8] years; 184 women [52.7%]; 66 Black [18.9%]; 199 White [57.0%]) demonstrated an area under the receiver operating characteristics curve of 0.91. A score of at least 6 points achieved highest accuracy (F score, 82.0), corresponding to a sensitivity of 81.5%, specificity of 85.9%, positive predictive value of 82.6%, and negative predictive value of 85.1% for AP diagnosis. Early computed tomography or magnetic resonance imaging was performed more often in participants predicted to have AP (116 of 155 [74.8%] with a score ≥6 vs 111 of 194 [57.2%] with a score <6; P < .001). Early imaging revealed an alternative diagnosis in 8 of 116 participants (6.9%) with scores of at least 6 points, 1 of 93 (1.1%) with scores of at least 7 points, and 1 of 73 (1.4%) with scores of at least 8 points.
UNASSIGNED: In this multicenter diagnostic study, the prediction model demonstrated excellent AP diagnostic accuracy. Its application may be used to avoid unnecessary confirmatory imaging.