超声联合成人阑尾炎评分预测成人复杂性急性阑尾炎的价值OA

Objective To explore the predictive value of ultrasound combined with adult appendicitis score(AAS)for the occurrence of complicated acute appendicitis(CAA)in adults.Methods This retrospective study was conducted on 104 patients with acute appendicitis who underwent appendectomy at Baotou Central Hospital from January 2021 to September 2024.According to the results of postoperative pathological examination,the patients were divided into a CAA group(n=55)and an uncomplicated acute appendicitis(UAA)group(n=49).The preoperative ultrasonic characteristics of the appendix and AAS were compared between the two groups.After screening out the indicators that may affect the occurrence of CAA through univariate analysis,a predictive model based on multivariate logistic regression was developed using the backward stepwise regression method.The model was internally validated using the bootstrap method(with 1000 resamplings),and ROC curves and calibration curves were plotted to evaluate performance of the model,and robustness across different stratified subgroups was analyzed.Results Results of multivariate logistic regression analysis showed that age,AAS,appendiceal fecalith,and periappendiceal effusion were independent risk factors for predicting the occurrence of CAA in adults(P<0.05).The combined regression model developed based on the above four risk factors showed good predictive performance,with a sensitivity of 85.5%and a specificity of 91.8%.Meanwhile,the combined model also had excellent discriminative ability,with the area under the curve(AUC)of 0.928(95%CI:0.875-0.982).DeLong test results show that the AUC value of the combined model is higher than that of the individual predictive models of age,AAS,appendiceal fecalith and periappendiceal effusion.Internal validation showed that the average AUC of the validation set was 0.917(95%CI:0.879～0.984),which was similar to the AUC of the original dataset.The results of both the calibration curve and Hosmer-Lemeshow test(χ2=11.442,P=0.178)indicate that good agreement between the predicted probability of the model and the actual occurrence probability.The AUC values of the age and appendiceal fecalith were similar to the overall AUC,indicating that the model has good robustness.Conclusion The combined model developed by ultrasound combined with AAS shows good discriminative ability and stability in the current dataset,which can provide a reference for clinicians to conduct rapid risk stratification of suspected patients.