对于诊断急性胆囊炎的床边得分的外部验证
Fatemeh Mahmoudzadeh1, Atousa Akhgar1, Hadi Mirfazaelian1
1Emergency Medicine Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Heliyon
|February 7, 2024
概括
一个新的床边临床评分有效帮助诊断急性胆囊炎,提供高灵敏度和特异性. 医生临床gestalt表现出可比的诊断性能,在急诊室设置中证明有价值.
科学领域:
- 紧急医疗 紧急医疗
- 胃肠病学 胃肠病学
- 诊断的准确性 诊断的准确性
背景情况:
- 由于症状与其他疾病重叠,急性胆囊炎的诊断可能具有挑战性.
- 右上象限 (RUQ) 腹部疼痛是一种常见的表现,但差异诊断需要仔细考虑.
研究的目的:
- 为了对诊断急性胆囊炎在急诊室 (ED) 患者的床边临床评分进行前性验证.
- 为了比较床边得分的诊断性能与医生临床gestalt.
主要方法:
- 一项前性观察性研究,涉及130名RUQ疼痛患者在三个学术ED.
- 床边得分包括症状,身体征兆 (RUQ疼痛,墨菲征兆) 和超声检查结果.
- 诊断确认涉及手术病理和/或30天的随访出院诊断;医生手势使用5分利克尔特尺度进行评估.
主要成果:
- 床边得分显示高灵敏度 (100%) 和负预测值 (100%) 的得分<4,有效排除胆囊炎.
- 评分≥6表明高特异性 (90.91%) 和积极的预测值 (83.67%),有助于在诊断中作出裁决.
- 医生gestalt (利克尔特尺度4-5) 显示高特异性 (95.45%) 和PPV (90.91%),诊断性能与床边得分相似 (AUC 97.58对95.37,p=0.35).
结论:
- 床边临床评分是裁决和排除ED中急性胆囊炎的宝贵工具.
- 医生临床格斯塔尔特表现出与验证的床边得分相匹配的诊断准确性.
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