بررسي ارزش معاينه مكرر بيماران مبتلا به درد غير اختصاصي شكم جهت كاهش موارد آپاندكتومي غير ضروري

A survey on the value of repeated clinical examination in patients with non-specific abdominal pain for reducing unnecessary appendectomy

Ohjective: Hospital observation along with repeated clinical examinations commonly use in patients with an equivocal diagnosis of appendicitis. The aim of this study was to assess the value of repeated clinical examinations in patients with non-specific abdominal pain in a university hospital in Hamedan. Subjects and Methods: Two hundred patients with equivocal diagnosis of appendicitis underwent a prospective study in Hamedan during year 2003 to 2005. We excluded patients with obvious evidence of acute appendicitis in a first clinical evaluation. From the time of admission, all the patients were examined and re-examined repeatedly every 4 and 6 hours during day and night shifts respectively for a maximum observation time of 48 hours. In patients who underwent surgery, the diagnosis was confirmed by pathological assessment. All the data were extracted manually and analyzed by SPSS 13 software with descriptive and analytic methods (Chi square and student t-test). Statistical significance was established at P<0.05. Results: The mean age was 25.03±11.53 (58 males and 142 females). There were no differences between male and female groups according to age and diagnosis. One hundred and fifty six (78%) patients were discharged without any surgical intervention and 44 patients underwent surgery. Among the operated cases, three patients had negative appendicitis and the rate of negative appendectomy was 6.82% with positive predictive value of 92.7%. Conclusion: Repeated examination is useful in accurate diagnosis and reducing unnecessary appendectomy in patients with equivocal signs and symptom of non-specific abdominal pain