Volúmen 34 No . 3 (2016)

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Browsing Volúmen 34 No . 3 (2016) by Author "Morocho Malla, Manuel Ismael"

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    Validación de la puntuación de apendicitis pediátrica (pas) frente a la escala de Alvarado, para el diagnóstico de apendicitis en niños de 4 a 15 años de edad
    (Universidad de Cuenca. Facultad de Ciencias Médicas, 2016-12) Tipán Barros, Jonathan Maximiliano; Morocho Malla, Manuel Ismael; Córdova Neira, Fernando Marcelo; Tipán Barros, Tatiana Maribel
    Background: The appendicitis is the most common surgical pathology in childhood. It is necessary an agile and accurate method to avoid excessive paraclinical examinations, diagnostic errors and unnecessary appendectomies. The systematic scores are the best processes for ordering clinical manifestations and reach the diagnosis. Objective: To validate simultaneously the pediatric appendicitis score (PAS) and Alvarado scales for the diagnosis of acute appendicitis in children aged from 4 to 15 years old with acute abdomen in pediatric emergencies of a third level hospital in the national health system. Materials and methods: A total of 161 patients aged from 4 to 15 years old were treated at the Vicente Corral Moscoso Hospital in the pediatric emergency service with clinical suspicion of acute appendicitis. They were applied the two scores before the surgery. The diagnosis was confirmed with histology. We compared the diagnostic capacity of PAS and Alvarado, and the proportion of agreement between tests with respect to the gold standard. Results: The sample had a predominance of males. The median age was 12 years, weight 37.5 ± 12.2 kg, height 138.5 ± 15.4 cm and 42% of malnutrition among those that were: emaciation, overweight and obesity. The sensitivity of PAS was higher (97.1 vs 79.8) although with lower specificity (50 vs 59). The negative predictive value of PAS was higher (73.1 vs 31.7). The agreements between histology and tests were higher for PAS (90.7% vs 74.5%). The 99% of phlegmonous appendicitis belonged to PAS and the 84% to Alvarado. More false negatives were produced with the Alvarado score (P <0.001). Conclusion: The PAS score is a reliable and easy diagnostic tool to use for deciding on acute appendicitis surgery suspected in children. Until the conclusive evidence is available, the use of both scores should be considered as a good clinical practice