Recent studies have reported promising outcomes of non-operative treatment for uncomplicated appendicitis; however, the preoperative prediction of complicated appendicitis is challenging. We developed models by incorporating fat stranding (FS), which is commonly observed in perforated appendicitis. We reviewed the data of 402 consecutive patients with confirmed acute appendicitis from our prospective registry. Multivariate logistic regression was performed to select clinical and radiographic factors predicting complicated acute appendicitis in our model 1 (involving backward elimination) and model 2 (involving stepwise selection). We compared c statistics among scoring systems developed by Bröker et al. (in J Surg Res 176(1):79–83. https://doi.org/10.1016/j.jss.2011.09.049 , 2012), Imaoka et al. (in World J Emerg Surg 11(1):1–5, 2016), Khan et al. (in Cureus. https://doi.org/1010.7759/cureus.4765 , 2019), Kim et al. (in Ann Coloproctol 31(5):192, 2015), Kang et al. (in Medicine 98(23): e15768, 2019), Atema et al. (in Br J Surg 102(8):979–990. https://doi.org/10.1002/bjs.9835 , 2015), Avanesov et al. (in Eur Radiol 28(9):3601–3610, 2018), and Kim et al. (in Abdom Radiol 46:1–12, 2020). Finally, we examined our models by performing the integrated discrimination improvement (IDI) test. Among enrolled patients, 64 (15.9%) had complicated acute appendicitis. We developed new 10-point scoring models by including the following variables: C-reactive protein, neutrophil to lymphocyte ratio, and computed tomography features of FS, ascites, and appendicolith. A cutoff score of ≥ 6 exhibited a high sensitivity of 82.8% and a specificity of 82.8% for model 1 and 81.3% and 82.3% for model 2, respectively, with c statistics of 0.878 (model 1) and 0.879 (model 2). Compared with the model developed by Bröker et al. which included C-reactive protein and the abdominal pain duration (c statistic: 0.778), the models developed by Atema et al. (c statistic: 0.826, IDI: 5.92%, P = 0.0248), H.Y Kim et al. (c statistics: 0.838, IDI: 13.82%, P = 0.0248), and our two models (IDI: 18.29%, P < 0.0001) demonstrated a significantly higher diagnostic accuracy. Our models and the scoring systems developed by Atema et al. and Kim et al. were validated to have a high diagnostic accuracy; moreover, our models included the lowest number of variables.

中文翻译：

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用于区分复杂性和非复杂性急性阑尾炎的阑尾周围脂肪链模型：一项诊断和验证研究

最近的研究报告了非手术治疗单纯性阑尾炎的有希望的结果。然而，复杂性阑尾炎的术前预测具有挑战性。我们通过结合脂肪绞合 (FS) 来开发模型，这在穿孔性阑尾炎中很常见。我们回顾了来自前瞻性登记的 402 例确诊为急性阑尾炎的连续患者的数据。在我们的模型 1（涉及向后消除）和模型 2（涉及逐步选择）中，进行多变量逻辑回归以选择预测复杂急性阑尾炎的临床和影像学因素。我们比较了 Bröker 等人开发的评分系统中的 c 统计量。（在 J Surg Res 176(1):79–83. https://doi.org/10.1016/j.jss.2011.09.049, 2012），Imaoka 等人。（在 World J Emerg Surg 11(1):1-5, 2016），Khan 等人。（在 Cureus 中。https://doi.org/1010.7759/cureus.4765，2019），Kim 等人。（在 Ann Coloproctol 31(5):192, 2015），Kang 等人。（在 Medicine 98(23): e15768, 2019），Atema 等人。（在 Br J Surg 102(8):979–990. https://doi.org/10.1002/bjs.9835, 2015），Avanesov 等人。（在 Eur Ra​​diol 28(9):3601–3610, 2018）和 Kim 等人。（在 Abdom Radiol 46:1-12, 2020）。最后，我们通过执行综合辨别改进 (IDI) 测试来检查我们的模型。在入组患者中，64 名（15.9%）患有复杂的急性阑尾炎。我们通过包括以下变量开发了新的 10 点评分模型：C 反应蛋白、中性粒细胞与淋巴细胞的比率以及 FS、腹水和阑尾结石的计算机断层扫描特征。≥ 6 的截止分数表现出模型 1 的 82.8% 和 82.8% 的高灵敏度和模型 2 的 81.3% 和 82.3% 的特异性，分别为 0.878（模型 1）和 0.879（模型 2）的 c 统计量。与 Bröker 等人开发的模型相比。其中包括 C 反应蛋白和腹痛持续时间（c 统计量：0.778），由 Atema 等人开发的模型。（c 统计量：0.826，IDI：5.92%，P = 0.0248），HY Kim 等人。（c 统计：0.838，IDI：13.82%，P = 0.0248），我们的两个模型（IDI：18.29%，P < 0.0001）显示出显着更高的诊断准确性。我们的模型和 Atema 等人开发的评分系统。和金等人。经验证具有较高的诊断准确性；此外，我们的模型包含的变量数量最少。Atema 等人开发的模型。（c 统计量：0.826，IDI：5.92%，P = 0.0248），HY Kim 等人。（c 统计：0.838，IDI：13.82%，P = 0.0248），我们的两个模型（IDI：18.29%，P < 0.0001）显示出显着更高的诊断准确性。我们的模型和 Atema 等人开发的评分系统。和金等人。经验证具有较高的诊断准确性；此外，我们的模型包含的变量数量最少。Atema 等人开发的模型。（c 统计量：0.826，IDI：5.92%，P = 0.0248），HY Kim 等人。（c 统计：0.838，IDI：13.82%，P = 0.0248），我们的两个模型（IDI：18.29%，P < 0.0001）显示出显着更高的诊断准确性。我们的模型和 Atema 等人开发的评分系统。和金等人。经验证具有较高的诊断准确性；此外，我们的模型包含的变量数量最少。