Premedicación, factor de retraso en el diagnóstico y tratamiento quirúrgico de la apendicitis aguda

Objective: To determine if pre-medication is a delay factor for the diagnosis and surgical treatment of patients with acute appendicitis. Setting: Second level health care hospital. Design: Prospective, comparative, longitudinal, and observational. Statistical analysis: Parametric tests, Chi Squire and Student t test for the analysis of variables. Material and methods: The study was performed in the Regional PEMEX Hospital in Salamanca, state of Guanajuato, Mexico, from January 1, 2006 to July 31, 2007. We analyzed the patients that sought medical care at the Emergency Service and coursed with clinical signs suggestive of acute appendicitis, of either sex, older than 5 years, with or without previous medication. Results: We studied 56 patients, 32 (57.1%) men and 24 (42.9%) women. Mean age was 29.44 + 17.65 years, range of 5 to 72. Appendectomy was performed in all patients, and the acute appendicitis diagnosis was confirmed with the histopathological result. Patients were divided in two groups, 23 (41.1%) in the non-medicated group and 33 (58.9%) in the medicated group; no statistically significant difference existed in terms of age and gender in the two studied groups (p < 0.05). The mean of hours elapsed between the start of symptoms and the decision to perform surgery was significantly lower in the non-medicated group than in the medicated group (23 hours, IC95% 16-23 vs 33 hours, IC95% 30-54; t = 3.9, p = 0.0001). Hospital stay days of nonmedicated patients were of 2.3 ± 1.6 vs 3 ± 1.3 days for the medicated ones, without significant difference (t = 1.2 y p = 0.22); however, there was a statistically significant difference in regard to the days of sick leave for the patients that received previous medication. Resumen Objetivo: Determinar si la premedicacion es factor de retraso en el diagnostico y tratamiento quirurgico en pacientes con apendicitis aguda. Sede: Hospital de segundo nivel. Diseno: Prospectivo, comparativo, longitudinal y observacional. Analisis estadistico: Pruebas parametricas, Chi cuadrada y t de Student para el analisis de las variables. Material y metodos: Se efectuo un estudio en el Hospital Regional de PEMEX, Salamanca, en el periodo del 01 de enero de 2006 al 31 de julio del 2007. Se analizaron los pacientes que acudieron al servicio de urgencias con cuadro clinico sugestivo de apendicitis aguda, de ambos generos, mayores de 5 anos de edad, con o sin medicacion previa. Resultados: Se estudiaron 56 pacientes, 32 (57.1%) fueron del sexo masculino, 24 del sexo femenino (42.9%). La media de edad fue de 29.44 + 17.65 anos con un rango de 5 a 72 anos. A todos se les realizo apendicectomia y se confirmo el diagnostico de apendicitis aguda con el resultado histopatologico. Se dividieron en dos grupos, 23 pacientes (41.1%) en el grupo de no medicados y 33 (58.9%) en el grupo de medicados; no hubo diferencia significativa en cuanto a edad y genero en los dos grupos de estudio (p < 0.05). La media de horas transcurridas entre el inicio de la sintomatologia a la toma de la decision quirurgica en el grupo de pacientes no medicados fue significativamente menor que la del grupo de pacientes medicados (23 horas, IC95% 16-23 vs 33 horas, IC95% 30-54; t = 3.9, p = 0.0001). Los dias de estancia hospitalaria en pacientes no medicados fueron de 2.3 ± 1.6 vs 3 ± 1.3 dias en los medicados, sin diferencia significativa (t = 1.2 y p = 0.22), sin embargo, si hubo www.medigraphic.org.mx