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¿Tiene este niño apendicitis?
David G Bundy1, Julie S Byerley, E Allen Liles
1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. dbundy3@jhmi.edu
JAMA
|July 27, 2007
Resumen
La fiebre y la sensibilidad al rebote son indicadores clave para el diagnóstico de la apendicitis en niños. Aunque no son definitivos, los signos clínicos combinados con los resultados de laboratorio ayudan a determinar la necesidad de cirugía o evaluación adicional.
Área de la Ciencia:
- Medicina Pediátrica La medicina pediátrica es una especialidad de la medicina pediátrica.
- Diagnóstico quirúrgico Diagnóstico quirúrgico.
- Epidemiología Clínica Epidemiología clínica.
Sus antecedentes:
- El dolor abdominal es una queja pediátrica común y a menudo desafiante.
- El diagnóstico preciso de la apendicitis en niños es crucial para reducir la morbilidad.
- La evaluación clínica ayuda a identificar a los niños que necesitan una consulta quirúrgica inmediata frente a un trabajo de diagnóstico adicional.
Objetivo del estudio:
- Evaluar sistemáticamente la precisión diagnóstica de los síntomas, signos y pruebas de laboratorio básicas para la apendicitis en niños.
- Evaluar la precisión de los hallazgos clínicos para diferenciar la apendicitis de otras causas de dolor abdominal.
- Informar la toma de decisiones clínicas para el manejo pediátrico del dolor abdominal.
Principales métodos:
- Revisión sistemática de los artículos en inglés de MEDLINE y de la base de datos Cochrane (1966-2007).
- Criterios de inclusión: estudios en niños (≤18 años) con sospecha de apendicitis, reporte de datos clínicos y diagnóstico confirmado a través de patología o seguimiento.
- Extracción de datos y evaluación de la calidad de 42 estudios incluidos.
Principales resultados:
- La fiebre (LR 3.4) y la sensibilidad al rebote (LR 3.0) son indicadores significativos de apendicitis en niños.
- La ausencia de fiebre (LR 0.32) y la sensibilidad de rebote (LR 0.28) disminuyen la probabilidad de apendicitis.
- El dolor abdominal migratorio (LR 1.9-3.1) y el recuento específico de glóbulos blancos (WBC <10,000/microL, LR 0.22; recuento absoluto de neutrófilos <6750/microL, LR 0.06) también ayudan en el diagnóstico.
- La combinación de síntomas y signos es la más efectiva para descartar la apendicitis.
Conclusiones:
- El examen clínico, aunque no es definitivo, es valioso para guiar la consulta quirúrgica o la evaluación diagnóstica adicional en la apendicitis pediátrica.
- La utilidad del examen clínico para el diagnóstico de la apendicitis en niños puede mejorarse con datos más específicos para el niño y estratificados por edad.
- La combinación de hallazgos clínicos con resultados de laboratorio mejora la precisión del diagnóstico de la apendicitis pediátrica.
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