Revista Colombiana de Cirugía (Dec 2011)
Utilidad de una escala diagnóstica en casos de apendicitis aguda Utility of a diagnostic scale scoring system in acute appendicitis
Abstract
Objetivo. Evaluar las puntuaciones de la escala diagnóstica de Alvarado en una serie de casos clínicos intervenidos quirúrgicamente con diagnóstico de apendicitis aguda. Materiales y métodos. Se trata de un estudio descriptivo de corte transversal. Se revisaron los registros clínicos de 101 casos sometidos a cirugía con diagnóstico de apendicitis aguda en el Hospital Regional de Duitama de enero a marzo de 2010. Para cada uno se estimó la puntuación alcanzada en la escala diagnóstica de Alvarado y se correlacionó con el resultado histopatológico, el tiempo de evolución, el sexo y la edad del paciente. Resultados. El 56,6 % correspondió a hombres y hubo 65,4 % de menores de 30 años. El tiempo promedio de evolución fue de de 44,6 horas. Se encontró asociación positiva entre evoluciones mayores de 36 horas y necrosis del apéndice (pObjective. To assess the Alvarado's diagnosis scores in a series of patients undergoing surgery with diagnosis of acute appendicitis. Materials and Methods. Descriptive, cross sectional study. The medical records of 101 cases that underwent surgery with diagnosis of acute appendicitis at Duitama's Regional Hospital, Duitama, Colombia, during the period January to March of 2010 were reviewed. The scores of the Alvarado's diagnostic scale were correlated with the histopathological results, time evolved before diagnosis, gender and age of the patient. Results. There were 56.6% male and 65.4% of patients were less than 30 years of age, median time evolved before diagnosis was 44.6 hours. Positive association was found between evolved time over 36 hours before diagnosis and necrosis of the appendix (p <0.01). Correlation of the diagnostic Alvarado score and histopathologic findings was 75.2%. The criteria that showed higher discriminating capacity were abdominal pain localized in the lower right quadrant, migration of pain, Blumberg´s sign, leukocytosis and neutrophilia (p <0.001); less discriminatory power were nausea/vomiting, fever, and anorexia. Conclusion. The Alvarado's diagnosis score, can be a very useful diagnostic tool to improve the timely and diagnostic efficacy in the acute appendicitis, especially in the outpatient and emergency services where high-level diagnostic aids such as images are not available.
