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首页> 外文期刊>Emergency medicine Australasia: EMA >Accuracy of clinician gestalt in diagnosing appendicitis in children presenting to the emergency department
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Accuracy of clinician gestalt in diagnosing appendicitis in children presenting to the emergency department

机译：临床医生甲甲酯在急诊部门诊断阑尾炎的准确性

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Abstract Objective Abdominal pain is a common paediatric presentation to the ED. Accurate diagnosis of acute appendicitis is challenging, with the best‐performing clinical scoring systems having sensitivities between 72% and 100%. The aim of this study is to assess the diagnostic accuracy of clinician gestalt according to seniority in diagnosing paediatric acute appendicitis in ED. Methods This is a prospective multi‐centre observational study of clinician's prediction of appendicitis in children under the age of 16?years presenting to four EDs with abdominal pain over a 1 month period at each site. Clinician‐estimated likelihood of acute appendicitis was compared with the final diagnosis determined by histopathology or operative findings and supplemented by telephone follow up for those without an operation. The primary outcome was diagnostic accuracy of clinician gestalt according to clinician seniority in diagnosing appendicitis. Results There were 381 children enrolled with completed clinician questionnaires, and 224 children had complete follow up or underwent appendicectomy. The median age was 9 years (interquartile range 6–12) and the incidence of appendicitis was 31/224 (13.8%, 95% confidence interval 9.3–18.4). The area under the curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value of clinician gestalt were 0.84 (0.76–0.91), 81% (63–93%), 76% (69–82%), 35% (28–42%) and 96% (92–98%), respectively, giving an overall diagnostic accuracy of 76% (70–82%). AUC stratified by clinician seniority (junior, intermediate and senior) were 0.89 (0.80–0.98), 0.82 (0.69–0.95) and 0.76 (0.56–0.96), respectively. Conclusions The diagnostic accuracy of ED clinician gestalt in paediatric appendicitis is comparable to current clinical scoring systems irrespective of seniority.
机译：摘要目的腹痛是ED的常见儿科介绍。准确诊断急性阑尾炎是具有挑战性的，最佳性能临床评分系统具有72％至100％的敏感性。本研究的目的是评估临床医生GESTALT的诊断准确性，根据诊断ED中的儿科急性阑尾炎。方法是，这是临床医生对16岁以下儿童阑尾炎的阑尾炎预测的前瞻性多中心观察研究，每年患有腹部疼痛的四个eds在每个网站的1个月内。临床医生估计的急性阑尾炎的可能性与通过组织病理学或手术结果确定的最终诊断进行了比较，并通过电话补充，因为没有手术的情况。根据临床医生资历诊断阑尾炎的临床医生GESTALT的诊断准确性是诊断准确性。结果381名儿童注册完成临床医生问卷，224名儿童完全跟进或接受阑尾切除术。中位年龄为9年（第6-12号间隔6-12级），阑尾炎的发生率为31/224（13.8％，95％置信区间9.3-18.4）。曲线（AUC）下的面积，敏感性，特异性，临床赖斯塔塔的阳性预测值和负预测值为0.84（0.76-0.91），81％（63-93％），76％（69-82％），35 ％（28-42％）分别为96％（92-98％），总体诊断准确性为76％（70-82％）。临床医生资历（初级，中级和高级）分层的AUC分层分别为0.89（0.80-0.98），0.82（0.69-0.95）和0.76（0.56-0.96）。结论ED临床医生甲甲酯在儿科阑尾炎中的诊断准确性与当前临床评分系统相比，无论资历如何。

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