Desarrollo de un Modelo para la Predicción de Coledocolitiasis: Análisis e impacto de la discriminación de riesgo en el uso de recursos
Palabras clave:
Riesgo, coledocolitiasis, umbrales, costos, predicción, Risk, prediction, choledocholithiasis, thresholds, costResumen
RESUMENIntroducción: La predicción de coledocolitiasis en pacientes con colelitiasis continúa siendo debatible. El objetivo de este estudio es diseñar un instrumento para la evaluación preoperatoria de pacientes con colelitiasis en riesgo de coledocolitiasis y determinar su impacto en el uso de recursos diagnósticos.
Materiales: Pacientes con colelitiasis- colecistitis aguda admitidos de urgencia. Análisis uni y multivariado de factores predictivos de coledocolitiasis. Determinación de Odds Ratio (OR) con Intervalos de confianza 95% (IC95%) p7mm, ALT, bilirrubina total. Escala evaluación 0-16 puntos con discriminación de umbrales de riesgo bajo, medio y alto; área bajo curva ROC 0.88. Validación prospectiva en cohorte 187 pacientes (área ROC: 0.87 p<0.001). Con el modelo se demuestra un impacto directo en uso de recursos según diferentes umbrales. El modelo ofrece mejor discriminación que otros identificados.
Conclusión: La predicción de coledocolitiasis debe involucrar una regla objetiva y la determinación de umbrales de riesgo, especialmente entre el grupo de bajo y mediano riesgo. Este enfoque permite el uso racional y eficiente de recursos diagnósticos.
Palabras clave: Riesgo, coledocolitiasis, umbrales, costos, predicción.
ABSTRACTIntroduction: Prediction of choledocholithiasis continues been debatable. The aim of this study is to design an instrument for the evaluation of patients in risk of choledocholithiasis due cholelithiasis and to determinate the impact in the use of diagnostic resources.
Materials: Patients with acute cholecystitis admitted in emergency setting. Single and multivariate analysis of predictive factors to determinate Odds Ratio (OR), with confidence Intervals of 95% (CI 95%), p7 mm, ALT and total bilirrubin. Development of a scale for the prediction of choledocholithiais, stratifying risk in low, intermediate and high groups. Area under ROC curve was 0.88. Prospective validation in a cohort of 187 patients (ROC area 0.87 p<0.001). Direct impact on cost savings. The model exhibit a better performance that other similar identified on medical databases.
Conclusion: Prediction of choledocholithiasis should be involved an objective prediction rule and the evaluation of thresholds, mainly for patients in low and intermediate risk. This approach conduces to the rational and efficient use of diagnostic resources.
Key words: Risk, prediction, choledocholithiasis, thresholds, cost.
Biografía del autor/a
Luis Carlos Domínguez, Hospital Universitario San Ignacio
Nelson Niño, Hospital Universitario San Ignacio
Oscar Rubio, Hospital Universitario San Ignacio
Eduardo Valdivieso, Hospital Universitario San Ignacio
Saúl Rugeles, Hospital Universitario San Ignacio
Álvaro Sanabria, Universidad de la Sabana (Chía, Colombia)
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