ACUTE APPENDICITIS: CLINICAL, SURGICAL AND PATHOLOGICAL CONCORDANCE IN A PERUVIAN EMERGENCY HOSPITAL

Abstract

Introduction: Acute appendicitis is the most frequent pathology in surgical emergencies. The timeliness and effectiveness of the diagnosis are parameters for evaluating the quality of care. Objective: To determine the concordance between clinical, surgical, and pathological diagnosis in patients with acute appendicitis, "José Casimiro Ulloa" Emergency Hospital, Lima - Peru, 2018. Methods: Observational, cross-sectional, retrospective, analytical study. Medical records of 222 patients diagnosed with acute appendicitis in 2018 were reviewed. Sample calculation with a known population (1200), probabilistic sampling. Patients > 18 years old diagnosed with acute appendicitis, operated on, who had a pathological study, excluding pregnant women and patients with comorbidities, were included. The data were processed and analyzed with SPSS v.25. Descriptive statistics and kappa coefficient were used to analyze concordance, using the Landis and Koch assessment: slight concordance (Kappa= 0.01-0.20), acceptable (0 .21-0.40), moderate (0.41-0.60), considerable (0.61-0.80) and almost perfect (0.81-1). Results: Adults (50.9%), males (56.8%) predominated. (83.8%) were clinically diagnosed with appendicitis requiring surgery. The predominant surgical diagnosis was suppurative appendicitis (32.4%), and the predominant pathological diagnosis was phlegmonous appendix (72.7%). A case of the normal appendix in anatomopathological diagnosis.Clinical-surgical diagnostic agreement was (kappa=4.18), clinical-pathological diagnosis (kappa=0.66), and surgical and pathological diagnosis agreement (kappa=0.497). Conclusions: Moderate concordance between clinical-surgical diagnosis and considerable clinical-pathological concordance diagnosis, reaffirming the clinical importance in decision-making for timely surgical intervention. Surgical and pathological diagnostic concordance was moderate, observing a moderate degree of certainty of the surgeons and pathologists.