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Factores asociados con la hospitalización o cirugía por dolor abdominal: un estudio retrospectivo
Hélène Bréchet1,2, Hélène Vanquaethem2, Raphaële Mestiri2
1Emergency Department, Bégin Military Teaching Hospital, Saint-Mandé, France.
Internal and emergency medicine
|February 24, 2026
Resumen
Distinguir el dolor abdominal agudo (DAA) grave del benigno es un desafío. Los indicadores clave para la hospitalización o cirugía incluyen dolor en la fosa ilíaca derecha, defensa abdominal, neutrofilia, niveles elevados de lipasa y PCR.
Área de la Ciencia:
- Medicina de Emergencias
- Gastroenterología
- Evaluación Quirúrgica
Sus antecedentes:
- El dolor abdominal agudo (DAA) representa un porcentaje significativo de las visitas al servicio de urgencias.
- Diferenciar las causas graves de las benignas de DAA es un desafío clínico.
- Identificar predictores de hospitalización o cirugía de emergencia es crucial para el manejo del paciente.
Objetivo del estudio:
- Identificar los factores asociados con la hospitalización o cirugía de emergencia en pacientes que presentan DAA.
- Analizar datos clínicos, de laboratorio y de imagen para determinar su valor predictivo.
Principales métodos:
- Un estudio observacional retrospectivo unicéntrico que involucró a 2201 pacientes con DAA.
- Análisis de 86 factores de registros médicos, comparando pacientes hospitalizados/sometidos a cirugía con pacientes dados de alta.
- Análisis multivariable para identificar predictores independientes.
Principales resultados:
- Cinco factores asociados de forma independiente con la hospitalización/cirugía: dolor en la fosa ilíaca derecha, defensa abdominal, neutrofilia, lipasa sérica >3x LSN y PCR >6 mg/L.
- Los hallazgos de la TC abdominal también se asociaron fuertemente con la hospitalización/cirugía cuando estuvieron presentes.
- La elevación de la lipasa sérica mostró un odds ratio particularmente alto (26,4) para la hospitalización/cirugía.
Conclusiones:
- La defensa abdominal, la neutrofilia y la PCR elevada son valiosas para distinguir el DAA grave del benigno.
- La localización del dolor en la fosa ilíaca derecha y la elevación de la lipasa sérica se asocian con una mayor probabilidad de hospitalización o cirugía de emergencia.
- Investigaciones adicionales en grupos de pacientes homogéneos pueden arrojar sistemas de puntuación útiles para la evaluación de la gravedad del DAA.
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