Análisis costo-efectividad del uso del algoritmo de Quebec en pacientes con luxación glenohumeral
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2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Problema. La luxación glenohumeral es la perdida de la relación anatómica entre la cabeza
humeral y la glena, es la luxación que se presenta con mayor frecuencia. La radiografía del
hombro afecto forma parte del gabinete de imágenes que a menudo son solicitadas en esta
patología. El uso inadecuado de radiografías en áreas de emergencias hospitalarias
representa un incremento del gasto de recursos hospitalarios y una radiación extra a los
pacientes que podrían ser manejados sin uso de una radiografía, por lo que introducir el
algoritmo de Quebec en el manejo de los pacientes con luxación glenohumeral nos va a dar
un enfoque y una estrategia diferente en el actuar de esta patología. Objetivo. Levar a cabo
una relación costo-efectividad del uso del Algoritmo de Quebec en pacientes con luxación
glenohumeral aguda. Metodología. Estudio de tipo aplicativo de nivel observacional,
analítico, retrospectivo y transversal que incluirá 105 pacientes con diagnóstico de luxación
glenohumeral atendidos en el servicio de urgencias de traumatología del Hospital Teodoro
Maldonado Carbo, desde enero 2016 a junio 2017. La gestión de datos se realizará en hojas
de cálculo de Microsoft Excel 365, donde se realizará el procesamiento de datos, para el
análisis estadístico se empleará el programa Megastat para Excel. Resultados. El mayor
número de luxaciones se presentó en pacientes menores de 40 años, encontramos
asociación significativa entre fractura y mecanismo lesional (traumático, atraumático)
(p=0,0086), así como relación entre el episodio de la luxación (primera vez, recurrentes) y
el hallazgo de fractura asociada a luxación glenohumeral aguda (p=0,0163).
Conclusiones. Aplicando el algoritmo de Quebec en los pacientes con luxación
glenohumeral tan solo el 27% de todas las radiografías hubieran sido realizadas. Es decir, el
uso de las radiografías podría reducirse hasta en un 73%; disminuyendo el gasto de
recursos hospitalarios empleados en esta patología, la radiación innecesaria y acortando el
tiempo de espera del paciente hasta el momento del alta.
Issue. The glenohumeral dislocation is the loss of the anatomical relationship between the humeral head and the glenoid, it is the dislocation that occurs most frequently. The x-ray of the affected shoulder is part of the cabinet of images that are often requested in this pathology. The inappropriate use of radiographs in hospital emergency areas represents an increase in the expenditure of hospital resources and extra radiation to patients that could be managed without the use of an x-ray, so that the Quebec algorithm should be introduced in the management of patients with glenohumeral dislocation will give us a different approach and strategy in the action of this pathology. Objective. To assess the cost-effectiveness of the use of the Quebec Algorithm in patients with acute glenohumeral dislocation. Methodology. An observational, analytical, retrospective and cross-sectional study of the application type that will include 105 patients diagnosed with glenohumeral dislocation treated in the trauma emergency department of Hospital Teodoro Maldonado Carbo, from January 2016 to June 2017. Data management will be carried out in Microsoft Excel 365 spreadsheets, where data processing will be performed, for the statistical analysis we will use the Megastat v. program. for Excel. Results. The greatest number of dislocations occurred in patients younger than 40 years, we found a significant association between fracture and lesion mechanism (traumatic, atraumatic) (p=0,0086), as well as relationship between the episode of dislocation (first time, recurrent) and the finding of fracture associated with acute glenohumeral dislocation (p=0,0163). Conclusions. Applying the Quebec algorithm in patients with acute glenohumeral dislocation, only 27% of all radiographs were performed. That is, the use of radiographs could be reduced by up to 73%; decreasing the expenditure of hospital resources used in this pathology, unnecessary radiation and shortening the waiting time of the patient until discharge.
Issue. The glenohumeral dislocation is the loss of the anatomical relationship between the humeral head and the glenoid, it is the dislocation that occurs most frequently. The x-ray of the affected shoulder is part of the cabinet of images that are often requested in this pathology. The inappropriate use of radiographs in hospital emergency areas represents an increase in the expenditure of hospital resources and extra radiation to patients that could be managed without the use of an x-ray, so that the Quebec algorithm should be introduced in the management of patients with glenohumeral dislocation will give us a different approach and strategy in the action of this pathology. Objective. To assess the cost-effectiveness of the use of the Quebec Algorithm in patients with acute glenohumeral dislocation. Methodology. An observational, analytical, retrospective and cross-sectional study of the application type that will include 105 patients diagnosed with glenohumeral dislocation treated in the trauma emergency department of Hospital Teodoro Maldonado Carbo, from January 2016 to June 2017. Data management will be carried out in Microsoft Excel 365 spreadsheets, where data processing will be performed, for the statistical analysis we will use the Megastat v. program. for Excel. Results. The greatest number of dislocations occurred in patients younger than 40 years, we found a significant association between fracture and lesion mechanism (traumatic, atraumatic) (p=0,0086), as well as relationship between the episode of dislocation (first time, recurrent) and the finding of fracture associated with acute glenohumeral dislocation (p=0,0163). Conclusions. Applying the Quebec algorithm in patients with acute glenohumeral dislocation, only 27% of all radiographs were performed. That is, the use of radiographs could be reduced by up to 73%; decreasing the expenditure of hospital resources used in this pathology, unnecessary radiation and shortening the waiting time of the patient until discharge.
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HOMBRO, LUXACION DEL HOMBRO, ALGORITMO DE QUEBEC, Radiografía, DIAGNOSTICO POR IMAGEN, HOSPITAL DE ESPECIALIDADES DR. TEODORO MALDONADO CARBO, CANTON GUAYAQUIL, ECUADOR, ANALISIS-COSTO BENEFICIO