在未确定超声波的成年患者中,急性尾炎的危险因素
Maria Doubova1, Miguel A Cortel-LeBlanc1,2,3, Mathieu Mckinnon1
1Department of Emergency Medicine, Clinical Epidemiology Unit, F6, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
CJEM
|October 24, 2024
概括
对于疑似尾炎和不明确的超声波患者,中性粒细胞数量升高和二次炎症迹象的缺失可以帮助排除尾炎. 这一发现有助于诊断尾炎的决策,当初始成像是不确定的.
科学领域:
- 医疗成像医学成像
- 诊断医学 诊断医学
- 紧急医疗 紧急医疗
背景情况:
- 腹部超声波是右下象限疼痛患者尾炎的主要诊断工具.
- 尾炎的超声波显著比例 (45-82%) 产生不确定的结果,需要进一步的成像,如计算机断层扫描 (CT).
- 有临床需要确定可靠排除尾炎的预测因子,当超声检查结果不确时.
研究的目的:
- 为了确定可以帮助排除尾炎的预测因子,在急诊室的患者中,腹部超声检查结果不确定.
- 根据特定的临床和成像变量制定排除尾炎的决策规则.
主要方法:
- 对成年急诊室患者进行了回顾性健康记录审查,这些患者的症状可疑为尾炎和不确定的超声波.
- 用多变量逻辑回归来识别预测因素,用于连续变量的立方线.
- 选择了一个节的模型来创建二进制决策规则,报告赔率比率 (OR) 和置信区间 (CI).
主要成果:
- 该研究包括463名患者;9.7%被诊断患有尾炎.
- 增加的中性粒细胞数量 (>5.5 × 10^9/L) 和超声波上的二次炎症迹象与尾炎的可能性更高相关 (分别为OR 1.21和2.16).
- 这两种预测因子的缺失表明,排除尾炎的高负预测值 (0.97),灵敏度为88.9%,特异性为45.7%.
结论:
- 在疑似尾炎和不确定的超声波的患者中,中性粒细胞数量升高和二次炎症迹象的缺失与尾炎的可能性较低有关.
- 这些发现表明,正常的中性粒细胞数量和没有二次超声波迹象的组合可以帮助排除尾炎.
- 这可能会减少对患者子集CT扫描等进一步调查的需要.
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