超声检查联合PAS、Alvarado评分系统在小儿急性阑尾炎诊断准确性研究

Diagnostic accuracy of ultrasound combined with PAS and Alvarado scoring system in children with acute appendicitis

目的:探讨超声检查联合PAS、Alvarado评分系统对小儿急性阑尾炎临床诊断的价值,为急性阑尾炎提供有效诊断方案。方法:选取2019年9月—2021年3月新疆维吾尔自治区儿童医院小儿外科收治的疑似阑尾炎而进行手术的患者148例,经过超声检查,采用PAS、Alvarado评分系统对其评分,并于手术后进行病理检查诊断。采用ROC曲线分析超声检查联合PAS、Alvarado评分系统对小儿急性阑尾炎诊断准确性研究。结果:超声检查敏感度为91.4%,特异度为87.5%,约登指数为0.79。PAS评分ROC曲线下的面积为0.810(95%CI:0.626~0.994,P<0.05);Alvarado评分ROC曲线下的面积为0.759(95%CI:0.599~0.919,P<0.05)。在PAS评分为≥5分时,其约登指数最高(J=0.55),敏感度92.1%,特异度62.5%,属于最佳临界值;在Alvarado评分为≥7分,其约登指数最高(J=0.40),敏感度77.1%,特异度62.5%,属于最佳临界值。PAS评分≥7分且超声检查为阳性时,其约登指数最高(J=0.81),敏感度93.6%,特异度87.5%,属于最佳临界值;Alvarado评分联合超声检查方面,Alvarado评分≥9分且超声检查为阳性时,其约登指数最高(J=0.80),敏感度92.9%,特异度87.5%,属于最佳临界值。结论:超声检查联合PAS或Alvarado评分系统,其诊断效能优于单一PAS、Alvarado评分、超声检查,值得临床上推广。

Objective To explore the diagnostic accuracy of ultrasound combined with PAS and Alvarado scoring system in the clinical diagnosis of acute appendicitis in children,and to provide an effective diagnostic scheme for acute appendicitis.Methods 148 patients with suspected appendicitis were selected from the pediatric surgery of children’s Hospital of Xinjiang Uygur Autonomous Region from September 2019 to March 2021,evaluated by ultrasound examination,PAS and Alvarado scoring system,and were diagnosed by pathological examination after operation.ROC analysis was used to study the diagnostic accuracy of ultrasonography combined with PAS and Alvarado scoring system in children with acute appendicitis.Results The sensitivity,specificity and Youden index of Ultrasound examination were 91.4%,87.5% and 0.79 respectively.The area under ROC of PAS score was 0.810(95% CI:0.626 ~ 0.994,P< 0.05);The area under the ROC of Alvarado score was 0.759(95% CI:0.599 ~ 0.919,P< 0.05).When the PAS score was≥5,the Youden index was the highest(J=0.55),the sensitivity was 92.1%,and the specificity was 62.5%,which was the best critical value.When Alvarado score was≥7,the Youden index was the highest(J=0.40),the sensitivity was 77.1%,and the specificity was 62.5%,which was the best critical value.When PAS score≥7 and ultrasound examination was positive,it was the best critical value;its Youden index was the highest(J=0.81),sensitivity was 93.6%,specificity was 87.5%.In the aspect of Alvarado score combined with ultrasound,when Alvarado score≥9and ultrasound examination was positive,it was the best critical value,with the highest Youden coefficient(J=0.80),sensitivity of 92.9%and specificity of 87.5%.Conclusion In this study,ultrasound,PAS score,Alvarado score have diagnostic value in the diagnosis of acute appendicitis in children.The diagnostic efficacy of ultrasound combined with PAS or Alvarado scoring system is better than that of single PAS,Alvarado score and ultrasound,which is worthy of clinical promotion.