Aplicación de la clasificación de Neff modificada en el manejo de la diverticulitis aguda / The use of the modified Neff classification in the management of acute diverticulitis

RESUMEN

Introducción: la diverticulitis aguda (DA) es cada vez más frecuente en los servicios de Urgencias. Es necesario un manejo seguro y eficaz con criterios de clasificación que permitan un tratamiento dirigido. Objetivo: verificar que la clasificación radiológica de Neff modificada (mNeff) asociada a criterios clínicos (síndrome de respuesta inflamatoria [SIRS] y comorbilidad) permite un manejo seguro de la DA. Material y métodos: estudio descriptivo prospectivo en una población de pacientes diagnosticados de DA mediante tomografía computarizada (TC). El protocolo consiste en la aplicación de la clasificación de mNeff y criterios clínicos de SIRS y comorbilidad que permiten tratamiento ambulatorio, ingreso, drenaje o cirugía. Resultados: el estudio comprende el periodo de febrero de 2010 a febrero de 2016, con un total de 590 episodios de DA en 271 mujeres y 319 hombres, con una edad mediana de 60 años (rango 25-92 años). Grados de mNeff grado 0 (408 pacientes, 70,6%) 376/408 (92%) tributarios a tratamiento domiciliario; alta 254/376 (67,5%); reconsultaron 33 pacientes y 22 reingresaron; éxito 91%. Grado Ia (52, 8,9%) 31/52 (59,6%) tributarios a tratamiento ambulatorio; alta 11/31 (35,5%); reconsultaron ocho e ingresaron cinco. Grado Ib (49, 8,5%) cinco cirugías y dos drenajes. Grado II (30, 5,2%) diez cirugías y cuatro drenajes. Grado III (5, 0,9%) una cirugía y un drenaje. Grado IV (34, 5,9%) diez pacientes con buena evolución con tratamiento conservador; 24/34 (70,6%) fueron intervenidos; colocamos 3/34 (8,8%) drenajes percutáneos. Conclusión: la clasificación de mNeff es una clasificación segura y aplicable basada en los hallazgos radiológicos de la TC. Junto con datos clínicos y de comorbilidad, permite un mejor manejo del cuadro de DA (AU)

ABSTRACT

Introduction: Acute diverticulitis (AD) is increasingly seen in Emergency services. The application of a reliable classification is vital for its safe and effective management. Objective: To determine whether the combined use of the modified Neff radiological classification (mNeff) and clinical criteria (systemic inflammatory response syndrome [SIRS] and comorbidity) can ensure safe management of AD. Material and methods: Prospective descriptive study in a population of patients diagnosed with AD by computerized tomography (CT). The protocol applied consisted in the application of the mNeff classification and clinical criteria of SIRS and comorbidity to guide the choice of outpatient treatment, admission, drainage or surgery. Results: The study was carried out from February 2010 to February 2016. A total of 590 episodes of AD were considered 271 women and 319 men, with a median age of 60 years (range 25-92 years). mNeff grades were as follows grade 0 (408 patients 70.6%); 376/408 (92%) were considered for home treatment; of these 376 patients, 254 (67.5%) were discharged and controlled by the Home Hospitalization Unit; 33 returned to the Emergency Room for consultation and 22 were re-admitted; the success rate was 91%. Grade Ia (52, 8.9%) 31/52 (59.6%) were considered for outpatient treatment; of these 31 patients, 11 (35.5%) were discharged; eight patients returned to the Emergency Room for consultation and five were re-admitted. Grade Ib (49, 8.5%) five surgery and two drainage. Grade II (30, 5.2%) ten surgery and four drainage. Grade III (5, 0.9%) one surgery and one drainage. Grade IV (34, 5.9%) ten patients showed good evolution with conservative treatment. Of the 34 grade IV patients, 24 (70.6%) underwent surgery, and three (8.8%) received percutaneous drainage. Conclusions: The mNeff classification is a safe, easy-to-apply classification based on CT findings. Together with clinical data and comorbidity data, it allows better management of AD (AU)