Correlación ecográfia, tomográfia y hallazgos quirúrgicos de apendicitis aguda
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2020
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Antecedentes: Las complicaciones en apendicitis aguda (AA) son peligrosas debido a que incrementan la morbimortalidad. Causa frecuente es el retraso diagnóstico por desconocimiento de la precisión diagnóstica de los métodos de imágenes para estudio abdominal, lo que causa incertidumbre en el cirujano y retrasa la toma de decisión terapéutica. Objetivos: Determinar la concordancia de la ecografía abdominal (EA) y la tomografía computada de abdomen (TCA) con los hallazgos quirúrgicos en pacientes indicados para cirugía por AA. Metodología: Se realizó un estudio de tipo transversal en el que se seleccionaron sin aleatorización 75 pacientes consecutivos atendidos en la emergencia de los Hospitales Clínicas del grupo Kennedy en Guayaquil-Ecuador por sospecha de AA que contaron con record quirúrgico, informe EA/TCA. Se excluyeron gestantes, masa palpable en fosa iliaca derecha, paciente con delirio/demencia, inmunocomprometidos. Para el análisis estadístico se calcularon, sensibilidad, especificidad, valores predictivos positivos/negativos, cociente de probabilidades positivos/negativos, precisión y coeficiente kappa de Cohen. Resultados: La prevalencia de AA fue 60%. La concordancia entre la TCA y el diagnóstico quirúrgico de AA fue casi perfecta (κ 0.83; p 0.000) con una precisión diagnóstica del 92%, S 86.67%, E 100% VPP 100%; VPN 83.33%; CPN 0.13 La EA con el diagnóstico de apendicitis fue sustancial (κ 0.663; p 0.000) y tuvo una precisión de 82.67%, S 71.11%; E 100%; VPP 100%; VPN 69.77%; CPN 0.29. Conclusiones: La concordancia y precisión de la tomografía para el diagnóstico de la apendicitis es alta mientras que para la ecografía es baja sin ser mala.
Background: Complications in acute appendicitis are dangerous because they increase morbidity and mortality. A frequent cause is the diagnostic delay due to ignorance of the diagnostic precision of the imaging methods, which causes uncertainty in the surgeon and delays the therapeutic decision-making. Objectives: To determine the concordance of abdominal ultrasound and abdominal computed tomography with surgical findings in patients indicated for surgery for acute appendicitis. Methodology: A cross-sectional study was carried out in which 75 consecutive patients treated in the emergency department of the Kennedy Group Hospitals from Guayaquil-Ecuador for suspected acute appendicitis were selected without randomization, with a surgical record, tomographic / ultrasound report. Pregnant women, palpable mass in the right iliac fossa, patient with delirium / dementia, immunocompromised were excluded. For the statistical analysis, sensitivity, specificity, positive / negative predictive values, positive / negative probability ratio, precision and Cohen's kappa coefficient were calculated. Results: The prevalence of appendicitis was 60%. The concordance between tomography and the surgical diagnosis of appendicitis was almost perfect (κ 0.83; p 0.000) with a diagnostic precision of 92%, S 86.67%, E 100% PPV 100%; NPV 83.33%; CPN 0.13 Ultrasound with the diagnosis of appendicitis was substantial (κ 0.663; p 0.000) and had a precision of 82.67%, S 71.11%; E 100%; PPV 100% NPV 69.77%. CPN 0.29. Conclusions: The concordance and accuracy of the tomography for the diagnosis of appendicitis is high while for the ultrasound it is low without being bad.
Background: Complications in acute appendicitis are dangerous because they increase morbidity and mortality. A frequent cause is the diagnostic delay due to ignorance of the diagnostic precision of the imaging methods, which causes uncertainty in the surgeon and delays the therapeutic decision-making. Objectives: To determine the concordance of abdominal ultrasound and abdominal computed tomography with surgical findings in patients indicated for surgery for acute appendicitis. Methodology: A cross-sectional study was carried out in which 75 consecutive patients treated in the emergency department of the Kennedy Group Hospitals from Guayaquil-Ecuador for suspected acute appendicitis were selected without randomization, with a surgical record, tomographic / ultrasound report. Pregnant women, palpable mass in the right iliac fossa, patient with delirium / dementia, immunocompromised were excluded. For the statistical analysis, sensitivity, specificity, positive / negative predictive values, positive / negative probability ratio, precision and Cohen's kappa coefficient were calculated. Results: The prevalence of appendicitis was 60%. The concordance between tomography and the surgical diagnosis of appendicitis was almost perfect (κ 0.83; p 0.000) with a diagnostic precision of 92%, S 86.67%, E 100% PPV 100%; NPV 83.33%; CPN 0.13 Ultrasound with the diagnosis of appendicitis was substantial (κ 0.663; p 0.000) and had a precision of 82.67%, S 71.11%; E 100%; PPV 100% NPV 69.77%. CPN 0.29. Conclusions: The concordance and accuracy of the tomography for the diagnosis of appendicitis is high while for the ultrasound it is low without being bad.
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Apendicitis aguda, Morbimortalidad, Ecografía abdominal, Tomografía, Hospital Clínica Kennedy Policentro, Hospital Clínica Kennedy Alborada, Cantón Guayaquil, Ecuador