探討急診室使用電腦斷層對於疑似闌尾炎病人之影響

Impact of Helical Computed Tomography on the Outcomes of Emergency Department Patients with Suspected Appendicitis

蕭志界(Chi-Jei Shiao) ； 王立敏(Lee-Min Wang) ； 陳燕嘉(Yen-Chia Chen) ； 陳啟華(Chii-Hwa Chen) ； 侯重光(Chrong-Kuang How) ； 黃俊一(Chun-I Huang) ； 陳振德(Jen-Dar Chen)

《Journal of Emergency Medicine, Taiwan》 6卷2期 (2004/06) Pp. 315-321

摘要

背景： 了解在急診室對於疑似闌尾炎之病人，使用電腦斷層之預後有何影響。
方法： 所有在急診室懷疑闌尾炎之病人，都作回溯性之比較。臨床上像是闌尾炎之病人，直接會診外科醫師處理。臨床上模稜兩可之病人，則安排電腦斷層檢查。追蹤方式是看手術結果或臨床表現。病人之預後則由進急診至手術之時間和闌尾破裂所占總數之比例來評估。
結果： 65個疑似闌尾炎之病人進入研究流程，其中53個病人有闌尾炎。29個病人因臨床高度懷疑未做電腦斷層檢查，直接會診外科醫師處理，手術後發現25人有闌尾炎(86%)。36個臨床上模稜兩可的病人安排電腦斷層檢查，其中28人有闌尾炎(78%)。男性病人從急診到手術之平均時間，經電腦斷層檢查費時597±64分鐘，沒作為378±40分鐘。女性病人從急診到手術之平均時間，經電腦斷層檢查費時628±65分鐘，沒作為323±56分鐘。闌尾炎破裂之比例，男性病人經電腦斷層為20%，沒作為30%。女性病人經電腦斷層為10%，沒作為21.4%。疑似闌尾炎之病人，使用電腦斷層之敏感度為96%，特異性為88%，準確度為94%。
結論： 在急診室對於疑似闌尾炎卻又模稜兩可之病人，使用電腦斷層具有高度之準確度及降低闌尾炎破裂之比例，但未能縮短病人從急診到手術的時間。

關鍵字

闌尾炎 ； 電腦斷層 ； 闌尾破裂

並列摘要

Objective: To understand how computer scanning can affect the outcome of emergency department (ED) patients suffering from suspected appendicitis.
Methods: A retrospective comparison of all ED patients suspected of suffering from appendicitis was conducted. Clinically, the patients who appeared to be suffering from appendicitis were referred directly to a surgeon for further treatment. Equivocal appendicitis cases, on the other hand, would be processed through computer scanning. Follow-up was dependent on the surgical results or the clinical observation. Prognosis was evaluated according to the time taken for a patient to move from ED to the operation room, as well as the proportion of the cases in which the appendix underwent rupture.
Results: Sixty-five suspected appendicitis cases are included in the research process, of which 53 patients actually suffered from appendicitis. Of these patients, 29 did not have computer scanning and were treated directly by the consulting surgeon, and 25 of these (86%) were confirmed to have appendicitis through surgery. Among the other 36 patients who were scheduled for computer scanning, 28 (78%) were found to have appendicitis. On average, it took 597+64 minutes for male patients who underwent computer scanning to move from the ED to the operation room, compared to 378+40 minutes for those who did not undergo computer scanning. On average, it took 628+65 minutes for female patients who underwent computer scanning to move from ED to the operation room, compared to 323+56 minutes for those who did not undergo computer scanning. Among the male patients who underwent through computer scanning, 20% experienced appendix rupture compared to 30% who did not undergo computer scanning. Among the female patients who went through computer scanning, 10% experienced appendix rupture compared to 21.4% who did not undergo computer scanning.
Conclusions: For ED patients equivocally suspected of suffering from appendicitis, computer scanning is highly accurate and helps to reduce appendix rupture. However, it does increase the time needed for a patient to move from ED to the operation room.

並列關鍵字

appendicitis ； computed tomography ； appendix rupture