This journal is
indexed in Scopus
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.
- Efimenko NA, Chursin VV, Stepnov AA. Lechebnaia i diagnosticheskaia laparoskopiia pri appenditsite. Voen-Med Zhurn [Therapeutic and diagnostic laparoscopy in appendicitis]. 2007;328(8):19–24.
- Sinenchenko GI, Kurygin AA, Bagnenko SF. Khirurgiia ostrogo zhivota [Acute abdomen surgery]. Saint-Petersburg, RF: Elbi-SPb; 2007. 512 p.
- Berry J Jr, Malt RA. Appendicitis near its centenary. Ann Surg. 1984 Nov;200(5):567–75.
- Kulezneva IuV, Izrailov RE, Lemeshko ZA. Ul'trazvukovoe issledovanie v diagnostike i lechenii ostrogo appenditsita [Ultrasound examination in the diagnosis and treatment of acute appendicitis]. Moscow, RF: GEOTAR-Media; 2009. 72 p.
- Tashtemirova OG, Manekenova KB, Aref'eva ZhA. Sposob identifikatsii virusnoi infektsii v bioptatakh cherveobraznogo otrostka [A method for identifying the viral infection in biopsy specimens of the appendix]. Nizhegorod Med Zhurn. 2005;(4):120–22.
- Brochhausen C, Bittinger F, Schmitt VH, Kommoss F, Lehr HA, Heintz A, Kirkpatrick CJ. Expression of E-selectin and vascular cell adhesion molecule-1 in so-called 'negative' appendices: first results to support the pathological diagnosis in borderline cases. Eur Surg Res. 2010;45(3-4):350–55.
- Filiz AI, Aladag H, Akin ML, Sucullu I, Kurt Y, Yucel E, Uluutku AH. The role of d-lactate in differential diagnosis of acute appendicitis. J Invest Surg. 2010 Aug;23(4):218–23.
- Koc M, Zulfikaroglu B, Kemal Isman F, Ozalp N, Acar A, Kucur M. Serum YKL-40 levels in acute appendicitis. Bratisl Lek Listy. 2010;111(12):656–58.
- Mentes O, Eryilmaz M, Harlak A, Yaman H, Yigit T, Ongoru O, Balkan M, Kozak O, Tufan T. The importance of urine 5-hydroxyindoleacetic acid levels in the early diagnosis of acute appendicitis. Am J Emerg Med. 2009 May;27(4):409–12.
- Yokoyama S, Takifuji K, Hotta T, Matsuda K, Nasu T, Nakamori M, Hirabayashi N, Kinoshita H, Yamaue H. C-Reactive protein is an independent surgical indication marker for appendicitis: a retrospective study. World J Emerg Surg. 2009 Oct 31;4:36
- Thuijls G, Derikx JP, Prakken FJ, Huisman B, van Bijnen Ing AA, van Heurn EL, Buurman WA, Heineman E. A pilot study on potential new plasma markers for diagnosis of acute appendicitis. Am J Emerg Med. 2011 Mar;29(3):256–60.
- Rezak A, Abbas HM, Ajemian MS, Dudrick SJ, Kwasnik EM. Decreased use of computed tomography with a modified clinical scoring system in diagnosis of pediatric acute appendicitis. Arch Surg. 2011 Jan;146(1):64–7.
- Natroshvili AG, Shulutko AM, Nasirov FN. Rezul'taty primeneniia modifitsirovannoi diagnosticheskoi shkaly u bol'nykh ostrym appenditsitom [The results of modified diagnostic scale application in patients with acute appendicitis]. Khirurgiia. Zhurn im NI Pirogova. 2010;(8):24–27.
- Slesarenko CS, Lisunov AIu. Osobennosti khirurgicheskoi taktiki i lecheniia ostrogo appenditsita na sovremennom etape [Features of surgical tactics and treatment of acute appendicitis at present]. Saratov Nauch-Med Zhurn. 2008; 3(21):111–18.
- Chong CF, Thien A, Mackie AJ, Tin AS, Tripathi S, Ahmad MA, Tan LT, Ang SH, Telisinghe PU. Comparison of RIPASA and Alvarado scores for the diagnosis of acute appendicitis. Singapore Med J. 2011 May;52(5):340–45.
603105, Rossiiskaia Federatsiia, g. N. Novgorod, ul. Izhorskaia, d. 25, k. 3, Nizhegorodskii voennyi gospital', khirurgicheskoe otdelenie,
Kasimov Rustam Rifkatovich
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.