Estudio de pacientes con pancreatitis aguda evaluados con la nueva guía del Colegio Americano de Gastroenterología.

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Title:	Estudio de pacientes con pancreatitis aguda evaluados con la nueva guía del Colegio Americano de Gastroenterología.
Alternate Title:	Study of patients with acute pancreatitis assessed with the new guide of the American College of Gastroenterology.
Authors:	Enrique Rodríguez-Olivares, Hugo¹, Sánchez-Pérez, Vanessa¹, Colín-Santiago, Martha¹, Zeferino Alberto-Infante, Osvaldo¹, Rebollo-Hurtado, Victoria¹, Antonio Aldana-Torices, Luis¹, Méndez-Valle, Jazmín¹, Alberto Motta-Ramírez, Gaspar¹, Mata-Melchor, Daniel¹, Arturo Cervantes-Velázquez, Jorge¹
Source:	Revista de Sanidad Militar. Mar/Apr2015, Vol. 69 Issue 2, p118-139. 22p. 2 Diagrams, 3 Charts, 7 Graphs.
Subjects:	PANCREATITIS diagnosis, GUIDELINES, AMERICAN College of Gastroenterology, PANCREATITIS treatment, SEVERITY of illness index, COMPUTED tomography, MILITARY hospitals
Abstract (English):	Background: Acute pancreatitis is a common illness with a typically benign course in the majority of cases. However, it causes a broad variety of complications ranging from mild edema to severe necrosis. Objective: To evaluate how the diagnosis of acute pancreatitis was established according to the new guidelines published by the American College of Gastroenterology. This diagnosis was corroborated by means of computerized tomography at Hospital Central Militar, Mexico. Material and method: An observational, retrospective, crosssectional and descriptive study of militar patients and users of Hospital Central Militar, referred and treated in the Emergency Department of adults, from September 19, 2013 to September 19, 2014. Patients were evaluated with ultrasonography and computerized tomography, and all of them showed acute pancreatitis. In the clinical records, patients evaluated with lipase, amylase, PCR, and triglycerides studies, Ranson's criteria, Marshall, APACHE II and BISAP scales during their hospitalization and patients who underwent ultrasonography and computerized tomography were intentionally identified. Results: One hundred and seventy-seven (100%) studies were included, of them, the most diagnosed acute pancreatitis (31%) was classified as Balthazar A. Seventy-three percent of patients were referred by acute pancreatitis and 23% had a different diagnosis. Of all patients, 121 (68%) who underwent ultrasonography were classified with: Balthazar A, 39; Balthazar B, 31; Balthazar C, 38; Balthazar D, 10 and Balthazar E, 3. Sixty-four ultrasound studies (53%) were normal and 40% non normal. In the intentional identification of patients, it was evident that evaluation did not comply with the National Clinical Guidelines nor with the new guide from the American College of Gastroenterology. Of all the patients, 20 (11%) were classified as Balthazar D and E. Conclusion: Treatment of acute pancreatitis and severe acute pancreatitis now has changed. The new paradigm in acute pancreatitis is: "less is more": less antibiotics, less fluid therapy, less surgery, all of that ultimately reduced morbidity and mortality rates, this concepts also included the number of computerized tomography and dynamic pancreatography studies, with the subsequent minor radiation and low consumption of material resources. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	Antecedentes: la pancreatitis aguda es una enfermedad común que normalmente tiene un curso benigno en la mayoría de los pacientes. Sin embargo, abarca un amplio espectro de complicaciones que van desde edema leve hasta necrosis severa. Objetivo: evaluar, mediante la nueva guía clínica del Colegio Americano de Gastroenterología, el proceso de atención que conllevó al diagnóstico de pancreatitis aguda y que fue comprobado por estudio de tomografía computada, en el Hospital Central Militar. Material y método: estudio observacional, retrospectivo, transversal y descriptivo, efectuado con pacientes militares y derechohabientes del Hospital Central Militar, referidos y atendidos en el Departamento de Urgencias de Adultos, en el periodo del 19 de septiembre de 2013 al 19 de septiembre de 2014 con evaluación de los estudios de ultrasonido y tomografía computada y con hallazgos por imagen de pancreatitis aguda. En los expedientes clínicos de todos los pacientes se identificaron intencionadamente a quiénes se realizó estudio de lipasa, amilasa, proteína C reactiva y triglicéridos; en quiénes se calculó la escala de severidad de Ranson, la escala de severidad de Marshall, la escala de severidad de APACHE II y la escala de severidad de BISAP durante su estancia hospitalaria, y a quienes se les realizó estudio de ultrasonido y de tomografía computada acorde con solicitud médica. Resultados: se recabaron 177 (100%) estudios de los que la pancreatitis aguda que más se diagnosticó (31% de los pacientes) se clasificó como Balthazar A. El 73% de los pacientes fueron referidos por pancreatitis aguda y en 23% el estudio se solicitó por un diagnóstico diferente a la pancreatitis aguda. De todos los pacientes, a 121 (68%) se les realizó ultrasonido con clasificación: Balthazar A: 39, B: 31, C: 38, D: 10 y E: 3; 64 (53%) resultaron normales y 40% anormales. En la identificación intencionada de pacientes se demostró escaso apego a las guías clínicas nacionales y a la nueva guía del Colegio Americano de Gastroenterología. De todos los pacientes, 20 (11%) obtuvieron clasificación Balthazar D y E. Conclusión: el tratamiento de la pancreatitis aguda y de la pancreatitis aguda severa ha cambiado. El concepto de "menos es más" es el nuevo paradigma en la pancreatitis aguda: menos antibióticos, menos fluidoterapia, menos cirugía, lo que a la larga condiciona menor morbilidad y mortalidad y ese concepto también incluye menor número de estudios de tomografía computada pancreatografía dinámica, con la subsiguiente menor radiación y menor consumo de los recursos materiales. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
Abstract:	Background: Acute pancreatitis is a common illness with a typically benign course in the majority of cases. However, it causes a broad variety of complications ranging from mild edema to severe necrosis. Objective: To evaluate how the diagnosis of acute pancreatitis was established according to the new guidelines published by the American College of Gastroenterology. This diagnosis was corroborated by means of computerized tomography at Hospital Central Militar, Mexico. Material and method: An observational, retrospective, crosssectional and descriptive study of militar patients and users of Hospital Central Militar, referred and treated in the Emergency Department of adults, from September 19, 2013 to September 19, 2014. Patients were evaluated with ultrasonography and computerized tomography, and all of them showed acute pancreatitis. In the clinical records, patients evaluated with lipase, amylase, PCR, and triglycerides studies, Ranson's criteria, Marshall, APACHE II and BISAP scales during their hospitalization and patients who underwent ultrasonography and computerized tomography were intentionally identified. Results: One hundred and seventy-seven (100%) studies were included, of them, the most diagnosed acute pancreatitis (31%) was classified as Balthazar A. Seventy-three percent of patients were referred by acute pancreatitis and 23% had a different diagnosis. Of all patients, 121 (68%) who underwent ultrasonography were classified with: Balthazar A, 39; Balthazar B, 31; Balthazar C, 38; Balthazar D, 10 and Balthazar E, 3. Sixty-four ultrasound studies (53%) were normal and 40% non normal. In the intentional identification of patients, it was evident that evaluation did not comply with the National Clinical Guidelines nor with the new guide from the American College of Gastroenterology. Of all the patients, 20 (11%) were classified as Balthazar D and E. Conclusion: Treatment of acute pancreatitis and severe acute pancreatitis now has changed. The new paradigm in acute pancreatitis is: "less is more": less antibiotics, less fluid therapy, less surgery, all of that ultimately reduced morbidity and mortality rates, this concepts also included the number of computerized tomography and dynamic pancreatography studies, with the subsequent minor radiation and low consumption of material resources. [ABSTRACT FROM AUTHOR]
ISSN:	0301696X