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Khirurgii

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Year 2014 Vol. 22 No 1

INFORMATION TECHNOLOGIES IN SURGERY

R.R. KASIMOV, A.S. MUCHIN, D.A. ELFIMOV, L.V. SOKOLOV

MEDICAL AND DIAGNOSTIC ALGORITHM IN MILITARY PERSONNEL WITH ACUTE APPENDICITIS

Bureau ¹ 5 of FSOI “1586 Military Clinical Hospital” of the Ministry of Defense of Russia Nizhny Novgorod Garrison Military Hospital1,
SBEE HPE “Nizhny Novgorod State Medical Academy” 2,
The Russian Federation

Objectives. To develop the available and effective model for diagnosis of an acute appendicitis.
Methods. On the first stage the retrospective analysis of case histories of the military personnel on an appeal, admitted to the garrison military hospital suspected of an acute appendicitis (n=202) during 10 years has been carried out. On the second prospective stage a new criterion, the determination of concentration of C reactive protein, has been included in the examination 40 patients (the main group). 39 patients of the main group were subjected to the targeted ultrasound scan of appendix. The first and the second stages were targeted to work out a diagnostic model and develop the diagnostic scales. Information analysis has been performed by means of the MS Excel tables, software for the discriminate analysis and design of diagnostic scales. The approbation of working out model has been conducted in the control group (n=30) in municipal medical institution.
Results. The original medical diagnostic algorithm of the acute appendicitis has been worked out. The definition of an acute appendicitis index according to original “ShPOA” and “ShOA” diagnostic scales is considered to be the algorithm basis. The algorithm discriminates the patients, allocates the patient group in which ultrasonic scan of an appendix is absolutely indicated. In case of impossibility of this study performance the algorithm focuses on dynamics of change of an acute appendicitis index. Characteristics of the summarized diagnostic scale of an acute appendicitis are: sensitivity – 94,1%, specificity – 100%, general accuracy – 96,7%, false negative answer – 5,9%, false positive answer – 0%, positive predicted value – 100%.
Conclusions. Universal systems of objective diagnostics of an acute appendicitis increase its accuracy with a error rate 13% for “ShPOA” and 1% for “ShOA”. Integration of determining the concentration of C reactive protein in the diagnostics system permitted to increase the general diagnostic accuracy of an acute appendicitis by 9,7%. The developed medical diagnostic algorithm of an acute appendicitis allows formulating the differentiated indications to application of additional methods of research as well as reducing the frequency of “unfounded” appendectomy.

Keywords: acute appendicitis, diagnostics of appendicitis, medical diagnostic algorithm, diagnostics scale, appendectomys
p. 89 – 95 of the original issue
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Address for correspondence:
603105, Rossiiskaia Federatsiia, g. N. Novgorod, ul. Izhorskaia, d. 25, k. 3, Nizhegorodskii voennyi gospital', khirurgicheskoe otdelenie,
e-mail: rusdoc77@mail.ru,
Kasimov Rustam Rifkatovich
Information about the authors:
Kasimov R.R. PhD, major of the military service, senior intern of the surgical unit of the bureau ¹ 5 of FSOI “1586 MCH” of the Ministry of Defense of Russia, Nizhny Novgorod.
Muchin A.S. MD, professor, a head of the surgery chair of the advanced training faculty of SBEE HPE “Nizhny Novgorod State Medical Academy of the Ministry of Public Health”.
Elfimov D.A. Major of the military service, a head of the surgical department of the bureau ¹ 5 of FSOI “1586 MCH” of the Ministry of Defense of Russia, Nizhny Novgorod.
Sokolov L.V. Lieutenant colonel of the military service, a head of the bureau ¹ 5 of FSOI “1586 MCH” of the Ministry of Defense of Russia, Nizhny Novgorod.
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