Evaluación de una vía clínica para la apendicitis infantil tras dos años de implantación

[Impact of imaging tests on the negative appendectomy rate]

INTRODUCTION

Negative appendectomies and perforated appendectomies have traditionally been quality indicators in surgery. The aim of this study is to analyze the emergency appendectomies in our hospital regarding the use of imaging tests and a review of the literature to analyze the quality of diagnosis in acute appendicitis.

MATERIAL AND METHODS

Retrospective study including all patients operated on for suspected acute appendicitis at a single institution for one year (2007). Data gathered from histology and imaging tests reports. Analysis of the histology results, imaging test used and its diagnostic accuracy. Comparison with quality levels published in the international literature.

RESULTS

A total of 394 patients were included in the study, the overall rate of negative appendectomy was 9.6%. Abdominal ultrasound (AU) was performed on 54.6% of patients and abdominal CT-scan on 10.2% of them, and 4.2% of the patients had both tests. AU positive predictive value was 82%. CT-scan positive predictive value was 97%.

CONCLUSION

The negative appendectomy rate (9.6%) in our centre shows values lower than the published ones in historical series but superior to the one published recently in the USA. The use of imaging tests in our hospital is lower than the one published in the USA, although similar to data reported in other European countries.

[Clinical pathway for women with locally advanced breast cancer and neoadjuvant chemotherapy]

Breast cancer is a very important public health issue, due its high incidence and mortality. Neoadjuvant chemotherapy has proven to be a valid option in the treatment of operable breast cancer and a better aesthetic result if breast- tumour ratio is unfavourable. The administration of the therapy itself is complicated, but the difficulty lies mainly in the management of side effects or adverse effects of the treatment. The emergence of a new therapeutic applications need to be constantly reviewed, which combined with the high work loads in the oncology day hospital requires easily managed, standardised and updated methodologies. A method of choice would be the use of clinical pathways that are just emerging in Spain, but could be helpful in managing this disease. The aim of this publication is to share the design of a clinical path for this specific disease with the scientific community. The process of preparing this document has been work of reflection, literature review and unification of criteria that may be used to facilitate work within the Oncology Day Hospital, improving the records of the work involved, especially those related to nursing practice. Their evaluation would enable proposals to be defined for improving and facilitating evidence-based practice.