Bonjour, Peut être faudra-t-il regarder du coté de l'écho ? Sensibilité 76-90% et spécificité 90-98% selon les analyses (les plus récentes étant bien évidement avec les chiffres les plus haut... logique) Pour : - Disponibilité supérieure - un prix sans comparaison avec le CT-scan - Irradiation nulle
Amicalement Philippe ----------------------------------------------------------------------- Dr Philippe Pès - SAMU 44 - CHU de NANTES E-Mail : [EMAIL PROTECTED] Collaborateur SAMU de FRANCE : http://www.samu-de-france.fr/ Collaborateur SFMU : http://www.sfmu.org (La médecine d'urgence) Webmaster du CMUPL : http://www.cmupl.org Web Perso : http://perso.club-internet.fr/ppes Corsicaria 2003 : http://www.corsicaria.org (Meeting aérien à Ajaccio) ------------------------------------------------------------------------ Afin de contribuer au respect de l'environnement, merci de n'imprimer ce mail qu'en cas de nécessité Le lundi 08 septembre 2008 à 06:35 -0700, Kenneth Chen a écrit : > Scan helico est plus precis que les judgements cliniques dans le > diagnostic de l'appendicite, meme dans les cas qui apparaitraient > cliniquement evidents... > > La valeur predictive positive de l'impression clinique du medecin > examinateur est de 73% et la valeur predictive negative et de 56%, > alors que celles du scan helico sont de 96% et 96%. > > > mais bon, il faudrait qu'on ait le luxe d'avoir toujours des > radiologues specialistes en scan et le scan serait toujours lu par 2 > radiologues... > > Ceci dit, le scan a probablement une indication plus forte pour les > femmes qui ont des taux de fausses positives et negatives plus eleves, > sauf si le chirurgien est tres sur de lui! > > > > et au prix de 1,000 mrem de radiation.... > > les tiers-payeurs et les soi-disants tres bons cliniciens n'aiment > surement pas cette etude, mais va-t-elle avoir une implication > medico-legale? > discussion ouverte > > > > > > Kim K et al. Impact of helical computed tomography in clinically > evident appendicitis. Emerg Med J 2008 Aug; 25:477. > > > Click here to read > > Department of Emergency Medicine, Seoul National University > Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, > Gyeongi-do 463-707, Korea. > > OBJECTIVES: To determine the utility of multidetector computed > tomography (MDCT) in patients with clinically evident acute > appendicitis and to compare the test characteristics of > overall clinical impression, Alvarado scores, and MDCT in > suspected appendicitis. METHODS: A prospective observational > cohort study was conducted in two urban emergency departments > (ED). Consecutive patients with suspected acute appendicitis > were clinically evaluated by an emergency physician who was > asked to determine whether appendicitis was clinically evident > or not. Elements of the Alvarado scores were collected and all > patients then underwent MDCT and a decision to operate, > observe, or discharge the patients was made by a surgeon. The > final diagnosis was based on surgical pathology or clinical > follow-up. The test characteristics of clinical impression, > Alvarado scores and MDCT were then calculated and the rates at > which acute appendicitis was falsely diagnosed based on > clinical impression and MDCT were compared using McNemar's > test. RESULTS: Of 157 study patients, 71 were considered to > have clinically evident appendicitis before MDCT and 91 had > findings of acute appendicitis on MDCT. 19 of the 71 patients > with clinically evident appendicitis did not have > appendicitis. 14 of 52 patients with an Alvarado score > or = > 8 also did not have appendicitis. Three of 91 patients with > acute appendicitis based on MDCT did not have appendicitis. > The specificities of clinical impression and Alvarado score > > or = 8 were 71.6% and 79.1%, respectively, and these were > significantly lower than that of MDCT (95.5%, p<0.05). > CONCLUSION: The performance of abdominal MDCT in patients with > a high degree of clinical suspicion for acute appendicitis > reduces the number of false positives and has the potential to > reduce negative appendectomies. > >
