改良Alvarado评分系统在成人急性阑尾炎治疗中的应用价值
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摘要
目的:探讨改良Alvarado评分系统在急性阑尾炎治疗中的应用价值。方法:回顾性收集2014年10月—2017年5月因急性阑尾炎于上海健康医学院附属第六人民医院东院行保守治疗的成年急性阑尾炎患者134例,采用改良Alvarado评分系统对患者初次就诊情况进行评分,结合患者出院后随访情况绘制受试者工作特性(ROC)曲线。结果:保守治疗有效组33例,改良Alvarado评分为3.70±0.31,中位数为4分,众数为4分;再手术组患者101例,改良Alvarado评分为7.23±0.14,中位数为7分,众数为7分。ROC曲线下面积为0.937,改良Alvarado评分系统得分最佳诊断截点为6分,此时的敏感度为90.1%,特异度为84.8%,阳性预测值为94.8%,阴性预测值为73.7%。结论:改良Alvarado评分系统对急性阑尾炎治疗方式的选择具有较高的判断价值,得分在6分以上可以考虑积极手术治疗,得分在6分以下可以考虑保守治疗。
Objective: To explore the value of modified Alvarado scoring system in the treatment of acute appendicitis. Method: Clinical data of 134 cases of acute appendicitis, who underwent conservative treatment in East Hospital of the Sixth People's Hospital Affiliated to Shanghai University of Medicine&Health Sciences from October 2014 to May 2017 were retrospectively collect-ed. The modified Alvarado scoring system was used to score in the first visit, then with their followup information to draw the receiver operating characteristic(ROC)curve. Result: 33 cases of conservative treatment group were effective, the modified Alvarado score was 3.70±0.31, the median was 4, and the mode was 4; The reoperation cases were 101, and the modified Alvarado score was 7.23±0.14, median. For 7 points, the mode wa s 7 points. The area under the ROC curve was0.937, and the best diagnostic cut-off point for the modified Alvarado scoring system was 6 points.The sensitivity at this cut-off was 90.1%, the specificity was 84.8%, the positive predictive value was 94.8%, and the negative predictive value was 73.7%. Conclusion: The modified Alvarado scoring system has a high judgment value for the treatment of acute appendicitis. When the modified Alvarado scoring system scores above 6 points it should be consider for surgical treatment, otherwise it maybe better for conservative treatment.
Objective: To explore the value of modified Alvarado scoring system in the treatment of acute appendicitis. Method: Clinical data of 134 cases of acute appendicitis, who underwent conservative treatment in East Hospital of the Sixth People's Hospital Affiliated to Shanghai University of Medicine&Health Sciences from October 2014 to May 2017 were retrospectively collect-ed. The modified Alvarado scoring system was used to score in the first visit, then with their followup information to draw the receiver operating characteristic(ROC)curve. Result: 33 cases of conservative treatment group were effective, the modified Alvarado score was 3.70±0.31, the median was 4, and the mode was 4; The reoperation cases were 101, and the modified Alvarado score was 7.23±0.14, median. For 7 points, the mode wa s 7 points. The area under the ROC curve was0.937, and the best diagnostic cut-off point for the modified Alvarado scoring system was 6 points.The sensitivity at this cut-off was 90.1%, the specificity was 84.8%, the positive predictive value was 94.8%, and the negative predictive value was 73.7%. Conclusion: The modified Alvarado scoring system has a high judgment value for the treatment of acute appendicitis. When the modified Alvarado scoring system scores above 6 points it should be consider for surgical treatment, otherwise it maybe better for conservative treatment.
引文
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[8]Mán E,Simonka Z,Varga A,et al.Impact of the Alvarado score on the diagnosis of acute appendicitis:comparing clinical judgment,Alvarado score,and a new modified score in suspected appendicitis:a prospective,randomized clinical trial[J].Surg Endosc,2014,28(8):2398-2405.
[9]Telem DA.Shared decision making in uncomplicated appendicitis:It is time to include nonoperative management[J].JAMA,2016,315(8):811-812.
[10]Kartal K,Yazici P,UnlüTM,et al.How to avoid negative appendectomies:Can US achieve this[J].Ulus Travma Acil Cerrahi Derg,2017,23(2):134-138.
[11]NN,Mohammed A,Shanbhag V,et al.A comparative study of RIPASAscore and Alvarado score in the diagnosis of acute appendicitis[J].J Clin Diagn Res,2014,8(11):Nc03-05.
[12]Ohle R,O’Reilly F,O’Brien KK,et al.The Alvarado score for predicting acute appendicitis:a systematic review[J].BMC Medicine.2011,9:139.
[13]Shuaib A,Shuaib A,Fakhra Z,et al.Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis[J].World J Emerg Med,2017,8(4):276-280.
[14]Kanumba ES,Mabula JB,Rambau P,et al.Modified alvarado scoring system as a diagnostic tool for acute appendicitis at bugando medical centre,Mwanza,Tanzania[J].BMC Surgery,2011,11:4.
[15]Zhang Z,Huang Y.A linear regression framework for the receiver operating characteristic(ROC)curve analysis[J].American J Biom Biostat.2012,3(2):5726.
[16]Hajian-Tilaki K.Receiver operating characteristic(ROC)curve analysis for medical diagnostic test evaluation[J].Caspian J Intern Med.2013,4(2):627-635.
[17]Tekeli MT,Ilhan E,Ureyen O,et al.How much reliable is alvarado scoring system in reducing negative appendectomy[J].Indian JSurg,2017,79(2):106-110.
[18]Yilmaz EM,Kapci M,Celik S,et al.Should Alvarado and Ohmann scores be real indicators for diagnosis of appendicitis and severity of inflammation[J].Ulus Travma Acil Cerrahi Derg,2017,23(1):29-33.
[19]Al-Faouri AF,Ajarma KY,Al-Abbadi AM,et al.The Alvarado score versus computed tomography in the diagnosis of acute appendicitis:a prospective study[J].Med J Armed Forces India,2016,72(4):332-337.
[2]Anderson JE,Bickler SW,Chang DC,et al.Examining a common disease with unknown etiology:trends in epidemiology and surgical management of appendicitis in California,1995-2009[J].World JSurg,2012,36(12):2787-2794.
[3]张伟耀,邓惠玲,朱峰正,等.急性阑尾炎CT检查的辅助诊断价值及鉴别诊断思路[J].中国普外基础与临床杂志,2013,20(12):1414-1416.
[4]Cariati A,Piromalli E.Conservative or operative management(open or laparoscopic)of acute appendicitis[J].Canadian Journal of Surgery,2012,55(3):E6.
[5]Actis GC,Pellicano R,Rosina F.Inflammatory bowel disease:Traditional knowledge holds the seeds for the future[J].World J Gastrointest Pharmacol Ther,2015,6(2):10-16.
[6]Nasiri S,Mohebbi F,Sodagari N,et al.Diagnostic values of ultrasound and the Modified Alvarado Scoring System in acute appendicitis[J].Int J Emerg Med,2012,5(1):26.
[7]Kamran H,Naveed D,Asad S,et al.Evaluation of modified Alvarado score for frequency of negative appendicectomies[J].J Ayub Med Coll Abbottabad,2010,22(4):46-49.
[8]Mán E,Simonka Z,Varga A,et al.Impact of the Alvarado score on the diagnosis of acute appendicitis:comparing clinical judgment,Alvarado score,and a new modified score in suspected appendicitis:a prospective,randomized clinical trial[J].Surg Endosc,2014,28(8):2398-2405.
[9]Telem DA.Shared decision making in uncomplicated appendicitis:It is time to include nonoperative management[J].JAMA,2016,315(8):811-812.
[10]Kartal K,Yazici P,UnlüTM,et al.How to avoid negative appendectomies:Can US achieve this[J].Ulus Travma Acil Cerrahi Derg,2017,23(2):134-138.
[11]NN,Mohammed A,Shanbhag V,et al.A comparative study of RIPASAscore and Alvarado score in the diagnosis of acute appendicitis[J].J Clin Diagn Res,2014,8(11):Nc03-05.
[12]Ohle R,O’Reilly F,O’Brien KK,et al.The Alvarado score for predicting acute appendicitis:a systematic review[J].BMC Medicine.2011,9:139.
[13]Shuaib A,Shuaib A,Fakhra Z,et al.Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis[J].World J Emerg Med,2017,8(4):276-280.
[14]Kanumba ES,Mabula JB,Rambau P,et al.Modified alvarado scoring system as a diagnostic tool for acute appendicitis at bugando medical centre,Mwanza,Tanzania[J].BMC Surgery,2011,11:4.
[15]Zhang Z,Huang Y.A linear regression framework for the receiver operating characteristic(ROC)curve analysis[J].American J Biom Biostat.2012,3(2):5726.
[16]Hajian-Tilaki K.Receiver operating characteristic(ROC)curve analysis for medical diagnostic test evaluation[J].Caspian J Intern Med.2013,4(2):627-635.
[17]Tekeli MT,Ilhan E,Ureyen O,et al.How much reliable is alvarado scoring system in reducing negative appendectomy[J].Indian JSurg,2017,79(2):106-110.
[18]Yilmaz EM,Kapci M,Celik S,et al.Should Alvarado and Ohmann scores be real indicators for diagnosis of appendicitis and severity of inflammation[J].Ulus Travma Acil Cerrahi Derg,2017,23(1):29-33.
[19]Al-Faouri AF,Ajarma KY,Al-Abbadi AM,et al.The Alvarado score versus computed tomography in the diagnosis of acute appendicitis:a prospective study[J].Med J Armed Forces India,2016,72(4):332-337.