Utilidad de la escala clínica de Rockall en la hemorragia digestiva alta no varicosa / Usefulness of Rockall clinical score in upper non variceal gastrointestinal bleeding

Introducción: la escala clínica de Rockall se utliza para clasificar la hemorragia digestiva alta en individuos atendiendo al riesgo de presentar sangrado activo, que necesiten de la realización urgente de la endoscopia digestiva. Objetivo: evaluar, la eficacia de la escala clínica de Rockall para identificar a los pacientes que requieren terapéutica endoscópica. Métodos: se realizó un estudio prospectivo. Se calculó el índice clínico de Rockall según escala homónima. Se realizó endoscopia de urgencia y terapéutica hemostática a pacientes con sangrado activo o reciente. La eficacia de este proceder se determinó mediante el análisis por curva de escala clínica de Rockall, índice de Youden y cálculo de sensibilidad y especificidad del mejor punto de corte. Resultados: incluidos 118 pacientes, 22 de los cuales (18,6 por ciento) recibieron terapéutica endoscópica por presentar sangrado activo o reciente. Índice clínico de Rockall con una media de 1,79 puntos. Riesgo alto 83 pacientes (70,3 por ciento) y bajo 35 casos (29,7 por ciento). La capacidad predictiva excelente, con valor del área bajo la curva = 0,960 (IC 95 por ciento: 0,904-1,017); punto de corte igual a 1 ( índice de Youden = 0,971) con una sensibilidad de 97 por ciento y de especificidad de 71 por ciento. Conclusiones: la escala clínica de Rockall puede ser utilizada con seguridad para la toma de decisiones en relación con la realización urgente de la endoscopia en el paciente con hemorragia digestiva alta no varicosa(AU)

Introduction: the clinical Rockall score serves to stratify the individuals with non variceal upper gastrointestinal hemorrhage depending on the risk of presenting active bleeding and therefore, they urgently need digestive endoscopy. Objective: to evaluate the effectiveness of the Rockwall clinical score in identifying patients who need therapeutic endoscopy. Methods: a prospective study with calculation of the Rockall clinical score according to a homonymous scale. Performance of urgent endoscopy and of therapeutic hemostatic endoscopy in patients with active or recent bleeding. Determination of efficacy through the analysis of ROC curves, Youden´s index and calculation of sensibility and specificity of the best cutoff point. Results: one hundred and eighteen patients were included, 22 of whom (18.6 percent) received therapeutic endoscopy to manage active or recent bleeding. Rocwall clinical score reached a mean of 1.79 points. It was found that 83 (70.3 percent) were high and 35 (29.7 percent) low risk patients. The predictive capacity was excellent, being the ABC= 0.960 (95 percent CI: 0,904-1,017). The cutoff point was 1 (J= 0.971) with 97 percent sensibility and 71 percent specificity. Conclusions: the Rockall clinical score can be safely used to make a decision on the urgent performance of endoscopy in patients with non-variceal upper gastrointestinal bleeding(AU)

Uso de una escala clínica predictiva para el diagnóstico de meningitis bacteriana en pediatría: [revisión] / Utility of a predictive score for the diagnosis of bacterial meningitis in children: [review]

La difícil interpretación de los hallazgos sugestivos de meningitis bacteriana y viral en el líquido cefalorraquídeo con frecuencia imposibilita su diferenciación. Por décadas, los investigadores han intentado crear escalas predictivas que permitan resolver tal disyuntiva. El objetivo del presente trabajo es determinar la validez y seguridad de una escala clínica predictiva para el diagnóstico de meningitis bacteriana en Pediatría. Realizamos un estudio retrospectivo, transversal, de evaluación de una prueba diagnóstica en una muestra de pacientes con edades entre 29 días y 12 años, egresados con diagnóstico de meningitis entre enero de 1992 y diciembre de 2006, del Deparatmento de Pediatría del Hospital "Dr. Jesús Yerena", ubicado en Caracas, Venezuela. aplicamos una escala clínica predictiva y calculamos su sensibilidad, especificidad, valores predictivos y razones de verosimilitud para el diagnóstico de meningitis bacteriana. La muestra estuvo conformada por 41 pacientes. Predomino el sexo masculino (n=29; 70,73 por ciento). El grupo etareo más afectado fue el de los lactantes menores (26=; 63,41 por ciento). Se identificaron 14 meningitis bacterianas y 27 asépticas. Mediante la escala clínica predictiva se clasificaron 31 meningitis como de alto riesgo de meningitis v¡bacteriana y 10 como de bajo riesgo. La sensibilidad y valor predictivo negativo fueron de 100 por ciento. La escala clínica predictiva resultó ser válida y segura para descartar meningitis bacteriana.

The overlapping of finding suggestive of bacterial or viral meningitis in cerebrospinal fluid makes it difficult to differentiate one of another. For decades, investigators have attempted to create clinical prediction scores to resolve such disjunctive. The objetive of this investigation was to determine the validity and safety of a clinical prediction score for the diagnosis of bacterial meningitis in childhood. We perfomed a retrospective, transversal, diagnosis test evaluation study of a sample of patients between 29 days to 12 years of age, dischanged from January 1992 to December 2006, with diagnosis of meningitis, from the Pediatrics Department of Dr. Jesús Yerena Hospital, in Caracas, Venezuela. The clinical prediction score was applied. We evaluated its validity and safety with the calculation of sensibility, specificity, predictive values and likelihood ratios for the diagnosis of bacterial meningitis. A total of 41 patients were included. Male gender was more common (n=29; 70,73%). The infant age group was predominant (n=26; 63,41%). We identified 14 bacterial meningitis and 27 aseptic meningitis. With the clinical predictin score, 31 meningitis were classified as high risk of bacterial meningitis and 10 as low risk. The sensibility and the negative value were 100%. The clinical prediction score applied resulted to be valid and safe for identifying patients without bacterial meningitis.

Determining ICH Score: can we go beyond? / Determinando o ICH Score: podemos ir além?

Spontaneous intracerebral hemorrhage (SICH) still presents a great heterogeneity in its clinical evaluation, demonstrating differences in the enrollment criteria used for the study of intracerebral hemorrhage (ICH) treatment. The aim of the current study was to assess the ICH Score, a simple and reliable scale, determining the 30-day mortality and the one-year functional outcome. Consecutive patients admitted with acute SICH were prospectively included in the study. ICH Scores ranged from 0 to 4, and each increase in the ICH Score was associated with an increase in the 30-day mortality and with a progressive decrease in good functional outcome rates. However, the occurrence of a pyramidal pathway injury was better related to worse functional outcome than the ICH Score. The ICH Score is a good predictor of 30-day mortality and functional outcome, confirming its validity in a different socioeconomic populations. The association of the pyramidal pathway injury as an auxiliary variable provides more accurate information about the prognostic evolution.

A hemorragia intracerebral (AVCH) espontânea ainda apresenta grande heterogeneidade em sua avaliação clínica, evidenciando diferenças nos critérios de inclusão utilizados nos estudos de tratamento da hemorragia intracerebral (ICH). O objetivo do presente estudo foi avaliar o ICH Score, uma escala simples e confiável, determinando a mortalidade em 30 dias e o resultado funcional após um ano. Pacientes consecutivos com AVCH espontâneo foram incluídos prospectivamente no estudo. O ICH Score variou de 0 a 4 e cada aumento no ICH Score esteve associado com um aumento na mortalidade em 30 dias e com uma progressiva diminuição nas taxas de bom resultado funcional. Entretanto, a ocorrência de injúria da via piramidal esteve melhor relacionada com um pior resultado funcional do que o ICH Score. O ICH Score é um bom preditor de mortalidade em 30 dias e resultado funcional, confirmando sua validade em diferentes populações socioeconômicas. A associação da injúria da via piramidal como variável auxiliar fornece informações mais precisas sobre a evolução prognóstica.