Utilidad y valor del Score de Alvarado en el diagnóstico de apendicitis aguda en la urgencia
Mots-clés :
medicina, apendicitis aguda, abdomen agudo, Score de AlvaradoRésumé
A pesar de los avances en la medicina moderna, el diagnóstico de la apendicitis aguda sigue siendo un desafío para el médico en general y el cirujano. Como sabemos, en esta patología definen las complicaciones, su morbilidad y su mortalidad, el diagnóstico temprano y la conducta quirúrgica oportuna, siendo muy bajas ante una apendicitis aguda operada a tiempo, y muy altas cuando se operan tardiamente. Se han establecido para facilitar el diagnóstico de esta patología varios sistemas de clasificación o scores, como por ejemplo RIPASA, Alvarado, Mantrels, Alvarado modificado, etc. Cada uno de ellos facilita una decisión temprana para el médico cirujano nobel y el médico generalista, ante un paciente con dolor abdominal. Por otro lado, se ha comparado la utilización del Score de Alvarado y su rendimiento en relación con métodos diagnósticos, como por ejemplo la TAC de abdomen, la ecografía abdominal, la proteína C reactiva y los hallazgos operatorios. Sin embargo, existen dificultades para poner en práctica estos sistemas, posiblemente, por falta de consenso sobre qué método utilizar, o de interés del cirujano formado, olvidándose que son muchos los médicos jóvenes que sin ser especialistas podrían beneficiarse de un sistema de puntuación clínico fácil de llevar a cabo y reproducible en situaciones precarias, ante pacientes con dolor abdominal en fosa ilíaca derecha de etiología dudosa. Creemos que el Score de Alvarado es el más útil, práctico y reproducible de estos sistemas de puntuación, y que con una muestra lo suficientemente grande podremos comprobar sin lugar a dudas la utilidad, especificidad y sensibilidad del mencionado Score.Téléchargements
Références
Alvarado A: A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med.15:557- 564(1986). https://doi.org/10.1016/S0196-0644(86)80993-3
Andersen B R, Kallehave F L, Andersen H K: Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database Syst Rev. 3:1439 (2005). https://doi.org/10.1002/14651858.CD001439.pub2
Balthazar E J, Rofsky N M, Zucker R. Appendicitis: The impact of computed tomography imaging on negative appendectomy and perforation rates. Am J Gastroenterol. 93:768-771 (1998). https://doi.org/10.1111/j.1572-0241.1998.222_a.x
Barber M D, McLaren J, Rainey J B: Recurrent appendicitis. Br J Surg. 84:110-2 (1997). https://doi.org/10.1046/j.1365-2168.1997.d01-1082.x
Bernard M, Berger J, Berger D H. En: Schwartz's, Shires, Spencer, Daly, Fischer, Galloway: Principles of Surgery Companion Handbook. Edit McGraw-Hill. New York. 8th ed. (2005). pp 1119-1138.
Bernays A C, Heidelberg M D: My recent work in appendicectomy. Med Rec 53:478-482 (1898).
Berry J, Malt R A: Appendicitis near its centenary. Ann Surg. 200:567-575 (1984). https://doi.org/10.1097/00000658-198411000-00002
Bright R, Addison T: Physicians to Guy's Hospital and Lecturers On The Practice Of Medicine. In: Inflammation of the Caecum an Appendix Vermiformis. Edit Richard and John E Taylor. London. 3th ed. 1839. pp 498-503.
Canavosso L, Carena P, Carbonell J M, Monjo L, Palas Zuñiga C, Sánchez M, Lada P E: Dolor en fosa ilíaca derecha y Score de Alvarado. Cir Esp. 83:247- 251(2008). https://doi.org/10.1016/S0009-739X(08)70562-1
Carlos Ocampo. En: Pedro Ferraina, Alejandro Oría. Cirugía de Michans. Edit El Ateneo. Buenos Aires. 5ªEdición. 2000. pp806-815.
Cecilia Hernández: Apendicitis Aguda: Rol de la Ecografía. Rev Arg de Ultrasonido. 6: 291-299 (2007).
Chan M Y, Tan C, Chiu M T, Ng Y Y: Alvarado Score: an admissions criterion in patients with iliac fossa pain. Surg J R Coll Surg Edinb Irel. 1:39-41 (2003). https://doi.org/10.1016/S1479-666X(03)80007-0
Chong C F, Adi M I W, Thien A, Suyoi A, Mackie A J, Tin A S, Tripathi S, Jaman N H,Tan K K, Kok K Y, Mathew V V, Paw O, Chua H B, Yapp S K: Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Med J. 51: 220(2010).
Cohen J: A coefficient of agreement for nominal scales. Educational and psychological measurement. 20: 37-46 (1960). https://doi.org/10.1177/001316446002000104
Davis G G: A transverse incision for the removal of the appendix. Ann Surg. 43:104-1 10 (1906). https://doi.org/10.1097/00000658-190601000-00012
Dawbarn R H M: A study in technique of operation upon the appendix. Int J Surg. 8:139-143 (1895).
DeArmond G M, Dent D L, Myers J G, Chopra S, Mumbower A L, Kumar A: Appendicitis: Selective use of abdominal CT reduces negative appendicectomy rate. Surg Infect. 4:213-8 (2003). https://doi.org/10.1089/109629603766957013
Deaver J B: Appendicitis. Edit P Blakiston's Son & Co. Philadelphia. 3rd ed. 1905. pp 1-139.
Denizbasi A, Unluer E E: The role of the emergency medicine resident using the Alvarado score in the diagnosis of acute appendicitis compared with the general surgery resident. European Journal of Emergency Medicine. 10:296-301(2003). https://doi.org/10.1097/00063110-200312000-00011
Douglas C D, Macpherson N E, Davidson P M, Gani J S: Randomized controlled trial of ultrasonography in diagnosis of acute appendicitis incorporing the Alvarado Score. BMJ. 321:919-923 (2000). https://doi.org/10.1136/bmj.321.7266.919
Douglas Ch D, Macpherson N E, Davidson P M, Gani J S: Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. BMJ. 321: 919 (2000). https://doi.org/10.1136/bmj.321.7266.919
Ekeh A P, Wozniak C J, Monson B, Crawford J, McCarthy: Laparoscopía en el manejo contemporáneo de la apendicitis aguda . Am J Surg. 193: 310- 314 (2007). https://doi.org/10.1016/j.amjsurg.2006.09.025
Eriksson S, Granström L, Olander B, Wretlind B: Sensitivity of interleukin-6 and C-reactive protein concentrations in the diagnosis of acute appendicitis. Eur J Surg. 161:41-45 (1995).
Fawcett T. ROC Graphs: Notes and Practical Considerations for Researchers. In: "http://home.comcast.net/~tom.fawcett/public_html/papers/ROC101.pdf"Technical report. Palo Alto (USA): HP Laboratories; (2004).
Fenyo G, Lindberg G, Blind P, Enochsson L, Oberg A: Diagnostic decision support in suspected acute appendicitis: validation of a simplified scoring system. Eur J Surg. 163:831-838 (1997).
Fingerhut A, Millat B, Borrie: Laparoscopic versus open appendectomy: time to decide. World J Surg. 8:835-845 (1999). https://doi.org/10.1007/s002689900587
Fisher M, Meates Dennis M: Is interval appendectomy necessary after successful conservative treatment of appendiceal mass in children. Arch Dis Child. 93:631-633 (2008). https://doi.org/10.1136/adc.2008.138966
Fleiss J L: Measuring nominal scale agreement among many raters. Psychol Bull. 76:378-382 (1971). https://doi.org/10.1037/h0031619
Ford R, Passinault W, Morse M: Diagnostic ultrasound for suspected appendicitis: Does the added cost produce a better outcome?. Am Surg. 60:895- 898 (1994).
Galindo Gallego M, Fadrique B, Nieto M A, Celleja S, Fernández Aceñero M J, Ais G: Evaluation of ultrasonography and clinical diagnostic scoring in suspected appendicitis. Br J Surg. 85:37-40 (1998). https://doi.org/10.1046/j.1365-2168.1998.00543.x
Gagne' J P, Billard M, Gagnon R, Laurion M, Jacques A: Province-wide population survey of acute appendicitis in Canada. New twists to an old disease. Surgical Endoscopy 21: 1383-1387(2007). https://doi.org/10.1007/s00464-007-9227-7
Garg C P, Vaidya B B, Chengalath M M: Efficacy of laparoscopy in complicated appendicitis. Int J Surg. 7:250-252 (2009). https://doi.org/10.1016/j.ijsu.2009.04.007
Gonzales A, Nogales A, Lesyk S, Abramzon F, Veintimilla Holguin V: Experiencia hospitalaria de médicos residentes en el diagnóstico ecográfico de apendicitis aguda. Rev Arg de Ultrasonido 9: 195-197 (2010).
Gurleyik E, Gurleyik G, Unalmiser S: Accuracy of serum C-reactive protein measurements in diagnosis of acute appendicitis compared with surgeon's clinical impression. Dis Colon Rectum. 38:1270-1274 (1995). https://doi.org/10.1007/BF02049151
Hong J J, Cohn S M, Ekeh A P, Newman M, Salama M, Leblang S D: Prospective randomized study of clinical assessment versus computed tomog-raphy for the diagnosis of acute appendicitis. Surg Infect. 4:231-9 (2003). https://doi.org/10.1089/109629603322419562
Hsien-Wei T, Jing-Tang W, Chien-Lung Ch, Shoei-Loong L, Min-Hsiung Ch: Decision Model for Acute Appendicitis Treatment With Decision Tree Technology-A Modification of the Alvarado Scoring System. Chin Med Assoc. Vol 73:No 8(2010). https://doi.org/10.1016/S1726-4901(10)70087-3
Izbicki J R, Knoefel W T, Wilker D K, Mandelkow H K, Müller K, Siebeck: Acurate diagnosis of acute appendicitis: a retrospective and prospective analysis of 686 patients. Eur J Surg. 158:227-231 (1992).
Jeerapa P,Taweesak T: The Modified Alvarado Score Versus the Alvarado Score for the Diagnosis of Acute Appendicitis. The THAI Journal of Surg 26:69- 72 (2005).
John R Potts III: Evaluating Acute Appendicitis: Does Everyone Need an Operation?: Highlights of the American College of Surgeons 94 th Annual Clinical Congress. In: www.medscape.org/viewarticle/586865.
Kalan M, Rich A J, Talbot D, Cuncliffe W J: Evaluation of modified Alvarado score in the diagnosis of acute appendicitis. Ann R Coll Surg Engl. 76:418- 419(1994).
Kelly H A, Hurdon E: The Vermiform Appendix and Its Diseases. In: Clinical History. Edit W B Saunders and Company. Philadelphia.1905. pp385-560.
Klingler A, Henle K P, Beller S, Rechner J, Zerz A, Wetscher G: Laparoscopic appendectomy does not change the incidence of postoperative infectious complications. Am J Surg. 175:232-235 (1998). https://doi.org/10.1016/S0002-9610(97)00286-9
Lada P E, Ochoa S, Rosso F, Ternengo D, Sánchez M, Di Benedetto N: Utilización del Score de Alvarado en el diagnóstico de apendicitis aguda. Pren Med Argent. 92:447-56 (2005).
Lada P, Brasesco O, Gramatica L, Montenegro R, Vaca A: Complicaciones del Divertículo de Ciego. Rev. Argent. Cirug. Extractos de Trabajos. 35:267 (1995).
Lada P, Martinessi V, Dutari Ch, Teyssedou C, Diyorio G, Gramática L, Struni M, Vaca A: Diverticulitis Cecal Aguda: Nuestra Conducta Terapéutica. Rev. Argent. Cirug. 82: 132-140 (2002).
Lada P, Martinessi V, Montenegro R, Dutari Ch, Florez F,Gramática L, Diyorio G, Vaca A: Estado Actual del Tratamiento Quirúrgico en la Diverticulitis Cecal Aguda. Rev. Fac. Cienc. Méd. Córdoba. 60: 63-70 (2003). https://doi.org/10.31053/1853.0605.v60.n2.36664
Landis J R, Koch G G: The measurement of observer agreement for categorical data. Biometrics. 33:159-174 (1977). https://doi.org/10.2307/2529310
Lane M J, Katz D S, Ross B A, Clautice-Engle T L, Mindelzun R E, Jeffrey J: Unenhaced helicoidal CT for suspected acute appendicitis. AJR Am J Roentgenol. 168:405-9 (1997). https://doi.org/10.2214/ajr.168.2.9016216
Latarjet-Ruiz Liard: Intestinum crassum. En: Anatomía Humana. Edit Panamericana. Buenos Aires. 3ª Edición. 1995. pp 1581-1591.
Laurel R, Imhoff, Alden H, Harken. En: Alden H, Harken, Ernest E, Moore: Cirugía Secretos. Edit Elsevier. Barcelona. 6ta edición. 2010. pp 187-190. https://doi.org/10.1016/B978-0-323-05711-0.00036-7
Lewis F R, Holcroft J W, Boey J, Dunphy E: Appendicitis: a critical review of diagnosis and treatment in 1000 cases. Arch Surg. 110:677-684 (1975). https://doi.org/10.1001/archsurg.1975.01360110223039
Maa J, Kirkwood K S. En: Courtney M T, Beauchamp R D, Evers B M, Mattox K L: Sabiston, tratado de cirugía. Edit Elsevier. Barcelona. 18va ed. 2009. pp 1333-1347.
Macklin C P, Radcliffe G S, Merei J M Stringer M D: A prospective evaluation of the modified Alvarado Score for acute appendicitis in Children. Ann R Coll Surg Engl. 79:203-205 (1997).
Major RH: Classic Descriptions of Disease. Edit Charles C. Thomas. Springfield. 3rd ed. 1945.
Markar S R, Venkat Raman V, Ho A, Karthikesalingam A, Kinross J, Evans J: Laparoscopic versus open appendicectomy in obese patients. Int J Surg. 9:451-5 (2011). https://doi.org/10.1016/j.ijsu.2011.06.005
McBurney C: Experience with early operative interference in cases of disease of the vermiform appendix. NY Med J. 50:676-684 (1889).
McBurney C: The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Ann Surg. 20:38-43 (1894). https://doi.org/10.1097/00000658-189407000-00004
Middleton S B, Whitbread T, Morgans B T, Mason P F: Combination of skin temperature and a single white cell count does not improve diagnostic accuracy in acute appendicitis. Br J Surg. 83:499-501 (1996). https://doi.org/10.1002/bjs.1800830419
Mosquera M, Kadamani A, Pacheco M, Villarreal R, Ayala J, Fajardo L, Prieto M, García O, Contreras H, Sánchez G, Herrera D, García J: Apendicectomía laparoscópica versus abierta: comparables. Rev Colomb Cir. 27:121-128 (2012).
Natalia Alarcón Thompson: Asociación entre Escala de Alvarado y diagnóstico de apendicitis aguda complicada y no complicada según anatomía patológica en el Centro Médico Naval. Rev Horiz Med. 12:2 (2012). https://doi.org/10.24265/horizmed.2012.v12n2.02
Ohle R, O'Reilly F, O'Brien K K, Fahey T, Dimitrov B D: The Alvarado score for predicting acute appendicitis: a systematic review. BMC Medicine. 9:139 (2011). https://doi.org/10.1186/1741-7015-9-139
Ortega A E, Hunter J G, Peter J H, Swanstrom L L, Schirmer B: A prospective, randomized comparison of laparoscopic appendectomy with open appendectomy. Laproscopic Appendectomy Study Group. Am J Surg. 169:208-212 (1995). https://doi.org/10.1016/S0002-9610(99)80138-X
Osler W: The coming of age of internal medicine in America. Int Clin. 4:1-5 (1915).
Owen T D, Williams H, Stiff G, Jenkinson L R, Rees B I: Evaluation of the Alvarado score in acute appendicitis. Journal of the Royal Society of Medicine. 85:87-88(1992). https://doi.org/10.1177/014107689208500211
Paulson E K, Kalady M F, Pappas T N: Suspected appendicitis. N Engl J Med. 3: 236-41 (2003). https://doi.org/10.1056/NEJMcp013351
Prado E, García Alcalá H, Domínguez Cocco A, Justo Janeiro J M: Comparative study of laparoscopic appendectomy Vs. open appendectomy. Rev Gastroenterol Mex. 62:254-9 (1997).
Rainey Williams G: Presidential Adress: A History of Appendicitis With Anecdotes Illustrating Its Importance. Ann Surg 197:495-506 (1983). https://doi.org/10.1097/00000658-198305000-00001
Rao P M, Rhea J T, Novelline R A, Mostafavi A A, McCabe C J: Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med. 338:141-6 (1998). https://doi.org/10.1056/NEJM199801153380301
Prinz R A, Madura J A. En: Baker R J, Fischer J E. El Dominio de la Cirugía. Edit Panamericana. Buenos Aires.4ta ed. 2004. pp 1743-1749.
Rockey A E: Transverse incision in abdominal operations. Med Rec. 68:779-780 (1905).
Royster H A: Appendicitis. New Orleans Medical and Surgical Journal. 80:12 (1928).
Salzberg A M, White N K: Current mortality for appendicitis in infants and children. Am J Surg. 115:651-652 (1968). https://doi.org/10.1016/0002-9610(68)90093-7
Sauerland S, Lefering R, Neugebauer E A M. Laparoscopic versus open surgery for suspected appendicitis. In: www.cochrane.org/cochrane-reviews.
Sauerland S, Jaschinski T, Neugebauer E A M: Laparoscopic versus open surgery for suspected appendicitis (review). Cochrane Library. 10:1-140 (2010). https://doi.org/10.1002/14651858.CD001546.pub3
Shelton T, McKinlay R, Schwartz R W: Acute appendicitis: current, diagnosis and treatment. Curr Surg. 60:502-505 (2003). https://doi.org/10.1016/S0149-7944(03)00131-4
Shepherd J A: Acute appendicitis a historical survey. Lancet. 2:299-302 (1954). https://doi.org/10.1016/S0140-6736(54)90236-6
Shera A H, Nizami F A, Malik A A, Naikoo Z A , Wani M A: Clinical Scoring System for Diagnosis of Acute Appendicitis in Children. Indian J Pediatr. 78:287-290 (2010). https://doi.org/10.1007/s12098-010-0285-9
Silen W. En: Fauci A S, Braunwald E, Isselbacher K J, Wilson J D, Martin J B, Kasper D L, Hauser S L, Longo D L: Harrison Principios de Medicina Interna. Edit Panamericana. Buenos Aires.16ta ed. 1998. pp 1883-1885.
Styrud J, Eriksson S, Nilsson I: Appendectomy versus antibiotic treatment in acute appendicitis. A prospective multicenter randomized controlled trial. World J Surg. 30:1033-1037 (2006). https://doi.org/10.1007/s00268-005-0304-6
Sung Ouk Jang, Byung Seok Kim, Duk Jin Moon: Application of Alvarado Score in Patients with Supected Appendicitis. Korean J Gastroenterol. 52: 27-32 (2008).
Teleford G L, Wallace J R: Apéndice. En: Zuidema G D, Yeo Ch J: Cirugía de Aparato Digestivo. Edit Panamericana. Buenos Aires. 5ªEdición. 2005. pp 208-219.
Waris S, Shah A, Munir A, Ahmed C, Ahme Bhutta I, Ali Malik S, Waqas A: Modified Alvarado Score: Accuracy in diagnosis of acute appendicitis in adults. Professional Med J. 17: 546-550 (2010). https://doi.org/10.29309/TPMJ/2010.17.04.2956
Winn R D, Laura S, Douglas C, Davidson P, Gani J S: Protocol-based approach to suspected appendicitis, incorporating the Alvarado score and outpatient antibiotics. Journal of Surgery. 74:324 (2004). https://doi.org/10.1111/j.1445-1433.2004.02993.x
Yıldırım E, Karagulle E, Kırbaş Í, Turk E, Hasdoğan B, Tekşam M, Coşkun M: Alvarado scores and pain onset in relation to multislice CT findings in acute appendicitis. Diagn Interv Radiol 14:14- 18(2008).
