Utilidad diagnóstica de la ecografía abdominal total y tomografía abdominal para apendicitis en adultos en el Hospital Militar Central

Ojeda Gavilán, Amalia Patricia; Roa, David Alejandro; Araque Diaz, Ivan

dc.contributor.advisor	Tafur Anzola, Álvaro	spa
dc.contributor.author	Ojeda Gavilán, Amalia Patricia
dc.contributor.author	Roa, David Alejandro
dc.contributor.author	Araque Diaz, Ivan
dc.contributor.other	Bautista, Camilo Andrés	spa
dc.coverage.spatial	Medicina	spa
dc.date.accessioned	2019-12-24T17:10:50Z
dc.date.accessioned	2019-12-30T19:08:17Z
dc.date.available	2019-12-24T17:10:50Z
dc.date.available	2019-12-30T19:08:17Z
dc.date.issued	2019-11-12
dc.identifier.uri	http://hdl.handle.net/10654/32930
dc.description.abstract	Se realizó un estudio de corte transversal con análisis de prueba diagnóstica, evaluando el rendimiento de las imágenes para el diagnóstico de apendicitis aguda, en pacientes mayores de 18 años con sospecha clínica de apendicitis atendidos en el Hospital Militar Central entre enero del 2016 y junio de 2018. Se revisaron 668 historias clínicas, a los cuales se les aplicaron los criterios de inclusión y exclusión, obteniendo 369 pacientes con ultrasonografía y 115 con tomografía abdominal. En pacientes con ultrasonografía la sensibilidad fue de 53% (IC95% 47-58) y especificidad de 72.2% (IC95% 58-85); en tomografía abdominal la sensibilidad fue de 88,2% (IC95%80-93) y la especificidad de 61,5% (IC95%31-86). Los datos mostraron que las características operativas tanto de la ultrasonografía como de la tomografía abdominal en nuestro hospital fueron poco favorables en la identificación de pacientes con apendicitis, con cifras por debajo a lo reportado en la literatura, lo que hace necesario la implementación de una evaluación sistematizada de signos directos e indirectos de apendicitis por imágenes diagnósticas en nuestro hospital que podría mejorar su rendimiento diagnóstico.	spa
dc.description.tableofcontents	TABLA DE CONTENIDO 1. RESUMEN ESTRUCTURADO 2. MARCO TEÓRICO 3. ESTADO DEL ARTE 4. IDENTIFICACIÓN Y FORMULACIÓN DEL PROBLEMA. 5. OBJETIVOS E HIPÓTESIS 6. METODOLOGÍA 7. PLAN DE ANÁLISIS 8. ASPECTOS ÉTICOS 9. RESULTADOS 10. DISCUSIÓN 11. CONCLUSIONES 12. REFERENCIAS BIBLIOGRÁFICAS 13. ANEXO	spa
dc.format	pdf	spa
dc.format.mimetype	application/pdf	spa
dc.language.iso	spa	spa
dc.language.iso	spa	spa
dc.publisher	Universidad Militar Nueva Granada	spa
dc.rights	Derechos Reservados - Universidad Militar Nueva Granada, 2019	spa
dc.rights.uri	https://creativecommons.org/licenses/by-nc-nd/2.5/co/	spa
dc.subject.mesh	RADIOLOGIA	spa
dc.subject.mesh	APENDICITIS	spa
dc.subject.mesh	ULTRASONOGRAFIA EN CIRUGIA	spa
dc.subject.mesh	ABDOMEN AGUDO	spa
dc.title	Utilidad diagnóstica de la ecografía abdominal total y tomografía abdominal para apendicitis en adultos en el Hospital Militar Central	spa
dc.type	info:eu-repo/semantics/bachelorThesis	spa
dc.rights.accessrights	info:eu-repo/semantics/openAccess	spa
dc.publisher.department	Facultad de Medicina	spa
dc.type.local	Trabajo de grado	spa
dc.description.abstractenglish	A cross-sectional study was performed with diagnostic test analysis, evaluating the performance of the images for the diagnosis of acute appendicitis, in patients over 18 years of age with clinical suspicion of appendicitis treated at the Central Military Hospital between January 2016 and June. 2018. 668 medical records were reviewed, to which the inclusion and exclusion criteria were applied, obtaining 369 patients with ultrasonography and 115 with abdominal tomography. In patients with ultrasonography the sensitivity was 53% (95% CI 47-58) and specificity 72.2% (95% CI 58-85); in abdominal tomography the sensitivity was 88.2% (95% CI 80-93) and the specificity 61.5% (95% CI 31-86). The data showed that the operative characteristics of both ultrasonography and abdominal tomography in our hospital were unfavorable in the identification of patients with appendicitis, with figures below those reported in the literature, which makes the implementation of an evaluation necessary. systematized direct and indirect signs of appendicitis by diagnostic imaging in our hospital that could improve its diagnostic performance.	eng
dc.title.translated	Diagnostic utility of total abdominal ultrasound and abdominal tomography for appendicitis in adults in the Central Military Hospital	spa
dc.subject.keywords	Appendicitis	spa
dc.subject.keywords	Multidetector Computed Tomography	spa
dc.subject.keywords	Ultrasonography	spa
dc.subject.keywords	Diagnostic imaging	spa
dc.publisher.program	Radiología	spa
dc.creator.degreename	Especialista en Radiología	spa
dc.description.degreelevel	Especialización	spa
dc.publisher.faculty	Medicina y Ciencias de la Salud - Radiología	spa
dc.type.dcmi-type-vocabulary	Text	spa
dc.type.version	info:eu-repo/semantics/acceptedVersion	spa
dc.rights.creativecommons	Atribución-NoComercial-SinDerivadas	spa
dc.relation.references	Cuervo JL. Apendicitis aguda. Rev Hosp Niño. 2014;56(252):15-31.	spa
dc.relation.references	Sohn M, Agha A, Bremer S, Lehmann KS, Bormann M, Hochrein A. Surgical management of acute appendicitis in adults : A review of current techniques. Int J Surg. 2017;48(October):232-239. doi:10.1016/j.ijsu.2017.11.028	spa
dc.relation.references	Ferris M, Quan ÃS, Kaplan ÃBS, et al. The Global Incidence of Appendicitis A Systematic Review of Population-based Studies. 2017;266(2):237-241. doi:10.1097/SLA.0000000000002188	spa
dc.relation.references	Gorter R, Eker H, Gorter-Stam M, Abis G, Acharya A, Col. Y. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc. 2016;30(11):4668-4690.	spa
dc.relation.references	Simel DL, Drummond R. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. (Cent). P (Bayl UM, ed.).; 2010.	spa
dc.relation.references	López JC, Martínez A, Zamarrón A, Gómez K. Apendicectomías negativas y su relación con los estudios de imagen. Cir Gen. 2011;33(4):222-226.	spa
dc.relation.references	Kularatna M, Lauti M, Haran C, Macfater W. Clinical Prediction Rules for Appendicitis in Adults : Which Is Best ? World J Surg. 2017. doi:10.1007/s00268-017-3926-6	spa
dc.relation.references	Kabir S, Kabir S, Sun R, Jafferbhoy S, Karim A. How to diagnose an acutely inflamed appendix; a systematic review of the latest evidence. Int J Surg. 2017;40:155-162.	spa
dc.relation.references	Horton M, Counter S, Florence M, Hart M. A prospective trial of computed tomography and ultrasonography for diagnosing appendicitis in the atypical patient. Am J Surg. 2000;179(5):379-38.	spa
dc.relation.references	Flum D, McClure T, Morris A, Koepsell T. Misdiagnosis of appendicitis and the use of diagnostic imaging. J Am Coll Surg. 2005;201(6):933-939.	spa
dc.relation.references	Flum D, Morris A, Koepsell T, Dellinger E. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA. 2001;286(14):1748-1753.	spa
dc.relation.references	Fernandez R. Imaging tests and acute appendicitis: the importance of quality health care. Rev Calid Asist. 2010;25(4):183–185.	spa
dc.relation.references	Rettenbacher T, Hollerweger A, Macheiner P, et al. Outer diameter of the vermiform appendix as a sign of acute appendicitis: evaluation at US. Radiology. 2001;218(3):757-762.	spa
dc.relation.references	Octavio E, Mauricio A, Moreno Luis. Apendicitis aguda: Hallazgos radiológicos y enfoque actual de las imágenes diagnósticas. Rev Colomb Radiol. 2014;25(1):3877-3888.	spa
dc.relation.references	Rybkin A, Thoeni R. Current concepts in imaging of appendicitis. Radiol Clin North Am. 2007;45(3):411-422.	spa
dc.relation.references	Brown M. Imaging acute appendicitis. Semin Ultrasound CT MR. 2008;29(5):293-307.	spa
dc.relation.references	Gongidi P, Bellah RD. Ultrasound of the pediatric appendix. Pediatr Radiol. 2017;47(9):1091-1100. doi:10.1007/s00247-017-3928-4	spa
dc.relation.references	Alter SM, Walsh B, Lenehan PJ, Shih RD. Ultrasound for Diagnosis of Appendicitis in a Community Hospital Emergency Department has a High Rate of Nondiagnostic Studies. J Emerg Med. 2017;52(6):833-838. doi:10.1016/j.jemermed.2017.01.003	spa
dc.relation.references	Nordin AB, Sales S, Nielsen JW, Adler B, Bates G, Kenney B. ScienceDirect Association for Academic Surgery Standardized ultrasound templates for diagnosing appendicitis reduce annual imaging costs. J Surg Res. 2017;221(614):77-83. doi:10.1016/j.jss.2017.07.002	spa
dc.relation.references	Fields JM, Davis J, Alsup C, et al. Accuracy of Point-of-care Ultrasonography for Diagnosing Acute Appendicitis : A Systematic Review and Meta-analysis. Acad Emerg Med. 2017;24(9):1124-1136. doi:10.1111/acem.13212	spa
dc.relation.references	Giljaca V, Nadarevic T, Poropat G, Nadarevic V, Stimac D. Diagnostic Accuracy of Abdominal Ultrasound for Diagnosis of Acute Appendicitis : Systematic Review and Meta-analysis. World J Surg. 2016;41(3):693-700. doi:10.1007/s00268-016-3792-7	spa
dc.relation.references	Parks N, Schroeppel T. J. Update on imaging for acute appendicitis. Surg Clin North Am. 2011;91:141-54. Surg Clin North Am. 2011;91(1):141-154	spa
dc.relation.references	Alore EA, Ward JL, Todd SR, Wilson CT, Gordy SD, Hoffman MK, Suliburk JW. Population-level outcomes of early versus delayed appendectomy for acute appendicitis using the American College of Surgeons National Surgical Quality Improvement Program. J Surg Res. 2018;(229):234-242	spa
dc.relation.references	Van Breda Vriesman AC, Kole BJ, Puylaert JB. Effect of ultrasonography and optional computed tomography on the outcome of appendectomy. Eur Radiol 2003;13:2278–2282	spa
dc.relation.references	Sivit C, Siegel M, Applegate K, Newman K. When appendicitis is suspected in children. Radiographics. 2001;21(1):247-262.	spa
dc.relation.references	Pinto N, Pereira J, Cunha R, Pinto P, Sirlin C. CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings. AJR Am J Roentgenol. 2005;185(2):406-417	spa
dc.relation.references	Wan MJ, Krahn M. Acute Appendicitis in Young Children : Cost-effectiveness of US versus CT in Diagnosis — A Markov Decision Analytic Model. Radiology. 2009;250(2):378-386.	spa
dc.relation.references	Yong D, Hoon K, Bin S, et al. Accuracy of low dose CT in the diagnosis of appendicitis in childhood and comparison with USG and standard dose CT ଝ. J Pediatr (Rio J). 2017;93(6):625-631. doi:10.1016/j.jped.2017.01.004	spa
dc.relation.references	Yun S, Cw R, Ny C, Hc K, Jy O, Dm Y. Comparison of Low- and Standard- Dose CT for the Diagnosis of Acute Appendicitis: A Meta-Analysis. AJR Am J Roentgenol. 2017;208(6):W198-W207. doi:10.2214/AJR.16.17274	spa
dc.relation.references	Velázquez C, Aguirre W, Valdivia C. et al. Valor del ultrasonido en el diagnóstico y manejo de la apendicitis aguda. Rev Gastroenterol Perú; 27: 259-263.	spa
dc.relation.references	Dibarboure P. Sciuto P. Machado F et al. Utilidad de la ecografía abdominal en los cuadros dolorosos agudos de la fosa ilíaca derecha con sospecha de apendicitis aguda. Experiencia del Hospital Maciel. Rev Med Urug 2010; 26: 6-13.	spa
dc.relation.references	Amgwerd M, Rothlin M, Candinas D, Schimmer R, Klotz HP, Largiader F. Ultrasound diagnosis of appendicitis by surgeons—a matter of experience? A prospective study. Langenbecks Arch Chir 1994; 379: 335-340	spa
dc.relation.references	Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C. Acute appendicitis: CT and US correlation in 100 patients. Radiology 1994; 190: 31-35	spa
dc.relation.references	Smith-Bindman R, Kerlikowske K, Feldstein Va, Subak L, Scheidler J, Segal M, et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 1998; 280: 1510-1517	spa
dc.relation.references	Crombe A, Weber F, Gruner L, Martins A, Fouque P, Barth X. Abdominopelvic ultrasonography in suspected acute appendicitis: Prospective study in adults. Ann Chi. 2000; 125: 57-61	spa
dc.relation.references	Deeks JJ. Systematic reviews of evaluations of diagnostic and screening tests. In: Egger M, Smith GD, Altman DG, editors. Systematic Reviews in Health Care: Meta-Analysis in Context. 2nd ed. London. BMJ Books, 2001: 248-281	spa
dc.relation.references	Kan JH, Fines BP, Funaki B. Conventional and hydrocolonic US of the appendix with CT correlation performed by on-call radiology residents. Acad Radiol 2001; 8: 1208-1214	spa
dc.relation.references	Kang WM, Lee CH, Chou YH, Lin HJ, Lo HC, Hu SC, et al. A clinical evaluation of ultrasonography in the diagnosis of acute appendicitis. Surgery 1989; 105: 154-159.	spa
dc.relation.references	Souparis AC, y Col. The role of ultrasound scanning of the lower abdomen in the differential diagnosis of acute appendicitis. Archives of Gastroenterohepatology 2000; 19: 28-30	spa
dc.relation.references	Sun SS, Wu HS, Wang JJ, Ho ST, Kao A. Comparison between technetium 99m hexamethylpropyleneamine oxide labeled white blood cell abdominal scan and abdominal sonography to detect appendicitis in adult patients with atypical clinical presentation. Abdominal Imaging 2002; 27: 734-738.	spa
dc.relation.references	Vermeulen B, y Col. Acute appendicitis: infl uenceof early pain relief on the accuracy of clinical and US findings in the decision to operate—a randomized trial. Radiology 1999; 210: 639-643	spa
dc.relation.references	Wise SW, y Col. Comparative assessment of CT and sonographic techniques for appendiceal imaging. Am J. Roentgenol	spa
dc.relation.references	American College of Radiology. Right lower quadrant pain-suspected appendicitis. ACR Appropriateness Criteria 2018. Disponible en: https://acsearch.acr.org/docs/69357/Narrative/	spa
dc.subject.proposal	Apendicitis	spa
dc.subject.proposal	Tomografía computarizada multidetector	spa
dc.subject.proposal	Ultrasonografía	spa
dc.subject.proposal	Imágenes diagnósticas	spa
dc.subject.proposal	Diagnóstico	spa
dc.subject.proposal	Diagnosis	spa
dc.description.abstractother	Foi realizado um estudo transversal com análise de teste diagnóstico, avaliando o desempenho de imagem para o diagnóstico de apendicite aguda, em pacientes acima de 18 anos com suspeita clínica de apendicite atendida no Hospital Militar Central entre janeiro de 2016 e junho. Foram revisados 668 prontuários, aos quais foram aplicados os critérios de inclusão e exclusão, obtendo 369 pacientes com ultrassonografia e 115 com tomografia abdominal. Nos pacientes com ultrassonografia, a sensibilidade foi de 53% (IC95% 47-58) e especificidade de 72,2% (IC95% 58-85); na tomografia abdominal, a sensibilidade foi de 88,2% (IC95% 80-93) e a especificidade de 61,5% (IC95% 31-86). Os dados mostraram que as características operatórias da ultrassonografia e da tomografia abdominal em nosso hospital foram desfavoráveis na identificação de pacientes com apendicite, com valores abaixo dos relatados na literatura, o que requer a realização de uma avaliação. sistematizou sinais diretos e indiretos de apendicite por diagnóstico por imagem em nosso hospital que poderiam melhorar seu desempenho diagnóstico.