Validación por Delphi sobre una propuesta de dos algoritmos y un esquema de procesos sistemáticos de atención, en pacientes con Mediastinitis Necrotizante Descendente.

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Bibliographic Details
Title:	Validación por Delphi sobre una propuesta de dos algoritmos y un esquema de procesos sistemáticos de atención, en pacientes con Mediastinitis Necrotizante Descendente.
Alternate Title:	Delphi validation of a proposal for two algorithms and a systematic care process scheme in patients with descending necrotizing mediastinitis.
Authors:	Daza Mier, Alvaro¹, Jemio Ojara, Fernando¹, Montero Barbery, Carlos¹, Santos Villca, Nelson Ovaldo¹, Gonzales Fernandez, Rosa¹
Source:	Gaceta Médica Boliviana. jul-dic2025, Vol. 48 Issue 2, p138-150. 13p.
Subjects:	ALGORITHMS, DENTAL pathology, DIABETES, DELPHI method, MORTALITY risk factors, INTENSIVE care units, OPERATIVE surgery, INTEGRATED health care delivery
Abstract (English):	Descending Necrotizing Mediastinitis (DNM) is a severe infection with high mortality, mainly linked to cervicofacial abscesses of dental or pharyngeal origin. Methods: this study, conducted in a tertiary hospital in Bolivia, proposes two algorithms and a structured, systematic approach to optimize the multidisciplinary management of these patients, validated through the Delphi method. A retrospective analysis of 28 DNM cases over ten years (2014-2023) showed that 50% originated from dental infections, with a mortality rate of 21,42%. Key risk factors included: age over 60 years (OR=14), diabetes combined with another chronic disease (OR=9), a delay of =14 days in seeking medical attention (OR=10,7), and ICU stays of =21 days (OR=9). Results: the proposed management strategy was validated through surveys of 30 specialists (surgeons, intensivists, etc.), evaluating three dimensions: preoperative, intraoperative, and postoperative care. Aiken's V demonstrated consensus levels of 90%; 92,1%, and 95,5% respectively, while Cronbach's alpha confirmed high reliability (0.801). The key algorithmic strategies include initial stabilization by internal medicine, early combined cervico-thoracic surgery, and standardized ICU follow-up protocols. Conclusions: the discussion emphasizes the importance of early diagnosis, aggressive surgical intervention, and multidisciplinary collaboration to reduce mortality rates. This systematic approach could improve patient care in tertiary hospitals, especially in areas with a high incidence of poorly managed dental infections. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	La Mediastinitis Necrotizante Descendente (MND) es una grave infección con elevada mortalidad, vinculada a problemas de abscesos cervicofaciales de procedencia dental o faríngeo principalmente. Métodos: el presente estudio investigativo llevado a cabo en un hospital de tercer nivel de Bolivia, sugiere dos algoritmos y una estructura de procedimientos sistemáticos para optimizar la gestión multidisciplinaria de estos pacientes, validados a través del método Delphi. Se examinaron retrospectivamente 28 casos de MND durante una década (2014-2023), resaltando que el 50% proviene de problemas dentales, registrando una mortalidad del 21,42%. Los factores de riesgo relevantes incluyeron: edad superior a 60 años (OR=14), diabetes vinculada a otra enfermedad crónica (OR=9), retraso =14 días en solicitar atención médica (OR=10,7) y, ingreso a la Unidad de Cuidados Intensivos =21 días (OR=9). Resultados: la estrategia de gestión fue comprobada a través de sondeos realizados a 30 especialistas (cirujanos, intensivistas, etc.), analizando tres dimensiones: preoperatorio, intraoperatorio y posoperatorio. La V de Aiken evidenció un consenso del 90%; 92,1% y 95,5% respectivamente, mientras que el Alfa de Cronbach corroboró una alta confiabilidad (0,801). Las estrategias algorítmicas destacan: primero estabilización por medicina interna, cirugía combinada temprana (cérvico-torácica) y seguimiento en la UTI con protocolos estandarizados. Conclución: la discusión subraya la importancia del diagnóstico temprano, intervención quirúrgica agresiva y colaboración multidisciplinaria para disminuir la tasa de mortalidad. Este método sistematizado, podría mejorar la atención en hospitales de tercer nivel, particularmente en zonas con alta incidencia de infecciones dentales mal gestionadas. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
Abstract:	Descending Necrotizing Mediastinitis (DNM) is a severe infection with high mortality, mainly linked to cervicofacial abscesses of dental or pharyngeal origin. Methods: this study, conducted in a tertiary hospital in Bolivia, proposes two algorithms and a structured, systematic approach to optimize the multidisciplinary management of these patients, validated through the Delphi method. A retrospective analysis of 28 DNM cases over ten years (2014-2023) showed that 50% originated from dental infections, with a mortality rate of 21,42%. Key risk factors included: age over 60 years (OR=14), diabetes combined with another chronic disease (OR=9), a delay of =14 days in seeking medical attention (OR=10,7), and ICU stays of =21 days (OR=9). Results: the proposed management strategy was validated through surveys of 30 specialists (surgeons, intensivists, etc.), evaluating three dimensions: preoperative, intraoperative, and postoperative care. Aiken's V demonstrated consensus levels of 90%; 92,1%, and 95,5% respectively, while Cronbach's alpha confirmed high reliability (0.801). The key algorithmic strategies include initial stabilization by internal medicine, early combined cervico-thoracic surgery, and standardized ICU follow-up protocols. Conclusions: the discussion emphasizes the importance of early diagnosis, aggressive surgical intervention, and multidisciplinary collaboration to reduce mortality rates. This systematic approach could improve patient care in tertiary hospitals, especially in areas with a high incidence of poorly managed dental infections. [ABSTRACT FROM AUTHOR]
ISSN:	10122966
DOI:	10.47993/gmb.v48i2.1040