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Asociación Mexicana de Gastroenterología

2006, Número 3

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Rev Gastroenterol Mex 2006; 71 (3)


Construcción de una escala clínica-ultrasonográfica para el diagnóstico de coledocolitiasis

Irineo-Cabrales AB, Zambada-Sentíes C, Garduño-Espinosa J, Mejía-Arreguin H, Vadillo-Ortega F, Osuna-Ramírez I

Idioma: Español
Referencias bibliográficas: 69
Paginas: 279-287
Archivo PDF: 83.08 Kb.


RESUMEN

Objetivo: describir la construcción de una escala clínica-ultrasonográfica para el diagnóstico de coledocolitiasis. Material y métodos: se trata de un estudio de pruebas diagnósticas retrolectivo hecho a partir de los expedientes de pacientes mayores de 18 años de edad, con diagnósticos relacionados con la presencia de ictericia, atendidos en tres centros hospitalarios de Culiacán, Sinaloa, durante el periodo de 1998 a 1999. Se recolectaron datos clínicos, de laboratorio y de gabinete; la colangiopancreatografía retrógrada endoscópica y la laparotomía exploradora se consideraron los estándares de oro. Se construyó una escala diagnóstica para coledocolitiasis mediante regresión logística y análisis multivariado utilizando componentes principales. Se estimaron la sensibilidad, especificidad, valores de predicción, razones de probabilidad (LR) positiva, negativa y curvas ROC de la escala. Se aplicó el modelo umbral para toma de decisiones médicas. Resultados: la sensibilidad de la escala para detectar coledocolitiasis fue de 98%, la especificidad fue de 95%, los valores predictivos positivos y negativos fueron 95% y 97%, respectivamente. El LR positivo estimado fue de 19.6 y el LR negativo de 0.02. Conclusiones: en pacientes adultos hasta los 70 años con ictericia de evolución aguda, la escala puede diagnosticar con seguridad coledocolitiasis, la prevalencia y/o probabilidad pretest no afecta de manera importante su exactitud para la toma de una decisión médica.


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