소아 충수돌기염 진단에서 Alvarado Scoring System의 유용성
Usefulness of a Alvarado Scoring System for the Diagnosis of Acute Appendicitis in Children
2
조회
0
다운로드
1
인용
0
참고문헌
초록
목 적: Alvarado score는 성인에서 급성 충수돌기염 환자의 조기 진단에 용이하고 오진율을 줄이는 유용한 진단법으로 알려져 있다. 저자들은 급성 복통이 주소인 소아 환아에서 급성충수돌기염 진단에 alvarado score의 유용성에 대하여 알아보고 진단의 정확성에 대하여 평가하고자 연구를 하였다. 방 법: 2002년 6월부터 2003년 5월까지 조선대학교 부속 병원 응급실을 방문한 복통을 호소하는 소아 170명 중 충수돌기염의 강하게 의심되는 122명을 대상으로 전향적으로 조사하였다. 복통을 주소로 방문한 환아의 나이, 임상증상, 임상징후, 혈액학적 검사결과를 분석하여 Alvarado score를 산출하고 진단을 위해 복부초음파 검사나 전산화 단층 촬영을 시행하고 수술을 시행한 경우 조직학적 진단을 하여 확진하였으며 수술하지 않은 군은 12시간의 추적 관찰로 확진하였다. 방사선학적 진단과 수술 결과 등을 비교하여 확진군과 오진군의 Alvarado score를 비교 분석하였다.결 과: 응급실에 복통이 주소인 환아 중 충수돌기염이 강하게 의심되었던 환아는 122명이었다. 122명의 환아 중 남아는 67명(54.9%), 여아는 55명(45.1%)이었다. 조직검사를 통해 충수돌기염으로 진단 받은 환자는 수술한 105명 중 92명으로 87.6%에 해당하였고 충수돌기염으로 수술한 환자들의 오진율은 12.4%였다. 평균 Alvarado score는 충수돌기염 군은 5.40 1.24, 충수돌기염이 아닌 군은 3.73 1.82이었다(p＜0.05). Alvarado score 6점 이상인 경우 소아 충수돌기염을 진단하는데 민감도가 86.4%, 특이도는 80.0%였다. 소아 충수돌기염을 진단하는데 복부 초음파검사나 전산화단층촬영의 진단의 민감도는 92.5%였다.
Abstract
Purpose: Alvarado scoring system was evaluated regarding its usefulness for the early diagnosis of acute appendicitis in adult and in reduction of the incidence of negative appendicectomies. To evaluate the accuracy of diagnosing appendicitis using the Alvarado score in children. Methods: Prospectively, we surveyed 122 patients (male 67, female 55) suffering from abdominal pain, who had visited to the emergency department of Chosun University Hospital from June 2002 to May 2003. The Alvarado score has been computed from the white blood cell count, neutrophil count, body temperature, resistance in the right lower quadrant, length of symptoms, nausea and vomiting. Each patient was evaluated by a pediatric resident and then by a general surgeon independently. Results: Out of 170 total children who visited to the emergency department due to abdominal pain, 122 patients were associated with appendicitis. A total of 122 patients (67 male and 55 female) were visited to the emergency room with suspected appendicitis. From 105 operated patients, 92 (87.6%) were diagnosed acute appendicitis and erronous diagnostic rate was 12.4%, pathologically. Mean alvarado score of appendicitis group was 5.40±1.24 whereas those of non-appendicitis group was 3.73±1.82 (p＜0.05). From 6 Alvarado score high sensitivity (86.4%) and high specificity (80.0%) were observed. Sensitivity of ultrasonography or computed tomography was 92.5%. Conclusion: We found that Alvarado score system is a noninvasive, safe diagnostic method, which is simple, reliable and repeatable. Alvarado score is useful system for a first, rapid and economic evaluation for the appendicitis in children. (Korean J Pediatr Gastroenterol Nutr 2004; 7: 1～7)
참고문헌 (20)
- Meier DE,, "Perforated appendicitis in children: is there a best treatment?", 38, pp.1520~1524 (2003)
- Smink DS, "The effect of hospital volume of pediatric appendectomies on the misdiagnosis of appendicitis in children", 113, pp.18~23 (2004)
- Alvarado A, "A practical score for the early diagnosis of acute appendicitis", 15, pp.557~64 (1986)
- Jawaid A, "Clinical scoring system:a valuable tool for decision making in cases of acute appendicitis", 49, pp.254~259 (1999)
- Zielke A,, "Validation of a diagnostic scoring system(Ohmann score)in acute appendicitis", 70, pp.777~783 (1999)
- Anatol TI, "A scoring system for use in the diagnosis of acute abdominal pain in childhood", 44, pp.67~69 (1995)
- Ramirez JM, "Practical score to aid decision making in doubtful cases of appendicitis", 81, pp.680~3 (1994)
- Francois Y, "Prospective study of a predictive scoring system for the diagnosis of appendicitis in patients with right lower quadrant pain", 15, pp.794~9 (1991)
- Blind PJ, "The continuing challenge of the negative appendix", 152, pp.623~7 (1986)
- Eskelinen M, "Sex-specific diagnostic scores for acute appendicitis", 29, pp.59~66 (1994)
- Teicher I, "Scoring system to aid in diagnoses of appendicitis", 198, pp.753~9 (1983)
- Weyant MJ, "Is imaging necessary for the diagnosis of acute appendicitis?", 37, pp.327~345 (2003)
- Kosloske AM, "The diagnosis of appendicitis in children:outcomes of a strategy based on pediatric surgical evaluation", 113, pp.29~34 (2004)
- Garcia Pena BM, "Selective imaging strategies for the diagnosis of appendicitis in children", 113, pp.24~28 (2004)
- Kalan M, "Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis:a prospective study", 76, pp.418~9 (1994)
- Denizbasi A, "The role of the emergency medicine resident using the Alvarado score in the diagnosis of acute appendicitis compared with the general surgery resident", 10, pp.296~301 (2003)
- McDonald GP, "Influence of preoperative computed tomography on patients undergoing appendectomy", 67, pp.1017~1021 (2001)
- Bhattacharjee PK, "Prospective evaluation of modified Alvarado score for diagnosis of acute appendicitis", 100, pp.310~311 (2002)
- Impellizzeri P, "Utility of a scoring system in the diagnosis of acute appendicitis in pediatric age", 57, pp.341~346 (2002)
- Stephens PL, "Comparison of ultrasound and the Alvarado score for the diagnosis of acute appendicitis", 63, pp.137~140 (1999)