[Diagnostic efficiency in acute appendicitis].

Abstract

Diagnostic efficiency and the means to achieve it constitute one of the main parameters that evaluates quality of hospital care within an institution. In addition, concerning surgery acute appendicitis is without doubt the most frequent pathology we face at our service. Therefore, we conceived of a way to determine degree of concordance and other parameters of diagnostic efficiency for this disease. This is an analytic, longitudinal study that took into account the cases of acute appendicitis out of the most frequent pathologies of surgical acute abdomen (acute appendicitis, perforated peptic ulcer, intestinal occlusion, and acute cholecystitis) from April 1 to June 17, 2002 for a total of two hundred cases. To establish correlation, main symptoms and signs upon admission were recorded, as well as presumptive, operatory, histopathologic, and laparoscopic diagnoses in cases in which such procedures were performed. Other aspects were also considered as efficiency parameters, namely Kappa correlation index, sensitivity, specificity, positive and negative predictive values, and positive and negative verisimilitude reasons. Clinical-surgical correlation found was very good, with Kappa value of 0.92. Clinical-pathological concordance was good also, with Kappa value of 0.71. The same can be said concerning the surgical-anatomopathologic case, with a value of 0.79. Regarding laparoscopy, both clinical-laparoscopic and surgical-laparoscopic concordances were poor, with Kappa value of 0.15. Also, concordance between laparoscopic and anatomopathologic diagnoses was weak, with a value of 0.25. Diagnostic efficiency in acute appendicitis was good, contrary to laparoscopic efficiency as diagnostic evidence.