随着时间的推移,尾炎的错误诊断是否减少? 一个基于人口的分析分析
D R Flum1, A Morris, T Koepsell
1Department of Surgery, Robert Wood Johnson Clinical Scholars Program, Box 357183, H-220 Health Sciences Center, University of Washington, Seattle, WA 98195-7183, USA. daveflum@u.washington.edu
尾炎的错误诊断率保持不变,尽管有CT扫描和腹腔镜等先进的成像技术. 这些技术并没有提高尾炎诊断的准确性,也没有降低一般人群中穿孔率.
科学领域:
- 医学诊断 医学诊断 医学诊断
- 外科手术的结果
- 公共卫生研究 公共卫生研究
背景情况:
- 尾炎的错误诊断导致不必要的手术,这是一个显著的不良结果.
- 已提出计算机断层扫描 (CT),超声波和腹腔镜等先进的成像方法,以减少不必要的尾切除术.
研究的目的:
- 评估CT,超声波和腹腔镜的引入和增加可用性是否导致尾炎在尾切除前误诊率下降.
主要方法:
- 使用华盛顿州医院出院数据 (1987-1998) 进行了一项基于人口的回顾性队列研究.
- 包括85,790名接受尾切除的居民,并分析了诊断码和人口统计数据.
- 对于急性尾炎 (穿孔或不穿孔) 和正常尾,尾切除的发病率根据年龄和性别标准化.
主要成果:
- 在63,707次非偶然性尾切除术中,15.5%是在没有尾炎的患者身上进行的.
- 在研究期间,不必要的尾切除和穿孔性尾炎的基于人口的比率没有显著变化.
- 误诊率每年在生育年龄的妇女中增加 (1%),在65岁以上的患者中显著增加 (8%),在5岁以下的儿童中保持稳定. 腹腔镜尾切除术的误诊比例 (19.6%) 比公开手术 (15.5%) 高.
结论:
- 尽管有先进的诊断工具,错误诊断的频率导致不必要的尾切除并没有减少.
- 引入CT,超声波和腹腔镜并没有导致尾炎穿孔率的降低.
- 随着先进的成像技术的广泛使用,尾炎在人口层面的诊断没有明显改善.
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