Publication: Biomarcadores diagnósticos de apendicitis aguda en pacientes pediátricos, atendidos por dolor abdominal en los servicios de urgencias españoles
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2022-10-17
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Universidad Complutense de Madrid
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Abstract
El dolor abdominal agudo (DAA) es uno de los motivos de consulta más frecuentes en los servicios de urgencias hospitalarios (SUH). La apendicitis aguda (AA) es uno de los principales diagnósticos diferenciales a tener en cuenta en la edad pediátrica y en los adolescentes, siendo la causa más frecuente de cirugía urgente en dicho grupo etario. A pesar de los avances, el diagnóstico sigue siendo difícil, especialmente en las edades más tempranas. La utilidad de la historia clínica y la exploración física puede ser menor en comparación con la población adulta ya que los niños se asocian a una mayor frecuencia de presentación clínica atípica. Se han publicado diversas escalas clínico-analíticas como herramientas de ayuda para el proceso diagnóstico de los pacientes con sospecha de AA, reduciendo el tiempo necesario para el diagnóstico, el número de pruebas de imagen y apendicectomías inadecuadas. La escala de Alvarado (EA), la más utilizada hasta el momento, combina síntomas y signos conjuntamente con datos analíticos como la leucocitosis y la neutrofilia y, en función de la puntuación, da recomendaciones sobre el alta, la observación y la necesidad de intervención quirúrgica. Sin embargo, la precisión de estas escalas en la población pediátrica no está bien evaluada. En la actualidad, también se están desarrollando líneas de investigación basadas en nuevos biomarcadores como el APPY1 Test, que es una aproximación multimarcador a pie de cama que podría servir para descartar AA de una forma rápida y segura...
Acute abdominal pain (AAP) is one of the most frequent reasons for consultation in emergency departments (ED). Acute appendicitis (AA) is one of the main differential diagnoses to take into account in children and adolescents, being the most frequent cause of urgent surgery in this age group. Despite the advances, the diagnosis remains difficult, especially in the younger ages. The usefulness of the medical history and physical examination may be less compared to the adult population since children are associated with a higher frequency of atypical clinical presentation.Various clinical-analytical scales have been published as helpful tools for the diagnostic process of patients with suspected AA, reducing the time required for diagnosis, the number of imaging tests, and inappropriate appendectomies. The Alvarado score (AS), the most used to date, combines symptoms and signs with analytical data such as leukocytosis and neutrophilia and, depending on the score, gives recommendations on discharge, observation and the need for surgical intervention. However, the precision of these scores in the pediatric population is not well evaluated. At present, lines of research are also being developed based on new biomarkers such as the APPY1 Test, which is a multi-marker approach at the bedside that could be used to rule out AA quickly and safely...
Acute abdominal pain (AAP) is one of the most frequent reasons for consultation in emergency departments (ED). Acute appendicitis (AA) is one of the main differential diagnoses to take into account in children and adolescents, being the most frequent cause of urgent surgery in this age group. Despite the advances, the diagnosis remains difficult, especially in the younger ages. The usefulness of the medical history and physical examination may be less compared to the adult population since children are associated with a higher frequency of atypical clinical presentation.Various clinical-analytical scales have been published as helpful tools for the diagnostic process of patients with suspected AA, reducing the time required for diagnosis, the number of imaging tests, and inappropriate appendectomies. The Alvarado score (AS), the most used to date, combines symptoms and signs with analytical data such as leukocytosis and neutrophilia and, depending on the score, gives recommendations on discharge, observation and the need for surgical intervention. However, the precision of these scores in the pediatric population is not well evaluated. At present, lines of research are also being developed based on new biomarkers such as the APPY1 Test, which is a multi-marker approach at the bedside that could be used to rule out AA quickly and safely...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 30-05-2022