小儿急性阑尾炎循证的计算机辅助诊断

Evidence-based and computer-assist for the diagnosis of acute appendicitis in children

目的 根据循证医学原理 ,采用计算机辅助的小儿阑尾炎评分系统对小儿阑尾炎病例进行分析 ,寻找增加诊断准确率的新方法。方法 检索文献 ,收集小儿急性阑尾炎的诊断证据 ,得出经评估在诊断中具有显著意义的征候 ,以Bayes条件概率数学模型 ,QBASIC语言编制计算机程序。采用该程序对 1999年 1月～ 2 0 0 3年 6月总计 2 37例入院诊断为急性阑尾炎小儿病例进行分析。结果 未手术组 83例 ,诊断概率均值为 0 .10 2 1± 0 .2 5 ;手术治疗组 15 4例 ,其中临床误诊组 8例 ,平均诊断概率为 0 .15 2 5± 0 .2 5 4 ;病理诊断为阑尾炎 14 6例 ,诊断概率 0 .8712± 0 .2 7,符合率 95 .89%。阑尾炎组诊断概率与误诊组或手术组相比P <0 .0 1。结论 本程序对小儿阑尾炎具有较高的诊断准确性 ,是一种简便、快捷和相对精确的辅助诊断工具 ,也适用于小儿阑尾炎治疗方法的选择。

Objective To define a method to enhance the accuracy in the diagnosis for acute appendicitis in children by using score system of computer-assisted and evidence-based medicine.Methods Evidences for the diagnosis of acute appendicitis in children in the literature were collected in Medline. Significant signs and symptoms were evaluated. A diagnosis program which based on Bayes probability math model was written by QBASIC language was used to analyse two hundred thirty-seven patients in whom acute appendicitis had been diagnosed at admission during Jan 1999 to June 2003. Results Medical treatment was used in 83 patients who had a mean probability value of 0.1021± 0.25. Operation was performed in 154 patients. Non-appendicitis pathological changes were diagnosed in 8 patients and the mean probability value was 0.1525± 0.254. Appendicitis was diagnosed pathologically in 146 cases who had a mean probability value of 0.8712± 0.27 (compared with that of Medical treatment group or non-appendicitis group, P< 0.01) and the accuracy rate was 95.89%. Conclusions This method is more accurate and it is a simple, rapid and relatively accurate supporting diagnostic tool. It is useful for choosing the treatment method for childhood appendicitis.