Generando matriz de evidencia

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Una característica única de Epistemonikos es que conecta las revisiones sistemáticas y sus estudios incluidos. Esto hace posible agregar las revisiones sistemáticas en base a los estudios primarios que tienen en común. El concepto de "revisiones sistemáticas compartiendo estudios incluidos" es un proxy de "revisiones sistemáticas respondiendo una pregunta similar"

Una matriz de evidencia es una forma tabular de desplegar el conjunto de revisiones sistemáticas que comparten estudios incluidos, y todos los estudios incluidos en estas revisiones. Es creado automáticamente a partir de las conexiones existentes en la base de datos, y puede ser editado por el usuario para que refleje más exactamente el conjunto de evidencia para la pregunta específica.

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La matriz de evidencia que será creada a partir de esta revisión contiene Revisiones sistemáticas / Estudios primarios. loading

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La matriz de evidencia es creada en base a los estudios primarios que las revisiones sistemáticas tienen en común. Por esta razón no es posible generar una matriz de evidencia desde una revisión que no incluyó ningún estudio

Este documento no permitirá generar una matriz hasta que los colaboradores de Epistemonikos completen la subida de información relevante. Si quiere que sea priorizada envía un correo a matrix@epistemonikos.org

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28 Estudios primarios 28.6%Ensayo controlado aleatorizado (ECA)8 / 28
Eriksson S1995Hansson J2009Vons C2011Turhan AN2009Styrud J2006Liu K2007Abeş M2007Salminen P2015Park HC2014Hansson J2012Malik AA2009Di Saverio S2014Svensson JF2015Mudri M2017Armstrong J2014Hartwich J2016Mahida JB2016Minneci PC2016Tanaka Y2015Minneci PC2014Gorter RR2015Kaneko K2004Steiner Z2015Caruso AM2017Park HC2011Koike Y2014Paudel GR2010Minneci PC2014
23 Revisiones sistemáticas
Liu ZH2014Fitzmaurice GJ2011Ansaloni L2011Varadhan KK2010Liu K2011Varadhan KK2012Mason RJ2012Sallinen V2016Rollins KE2016Podda M2017Harnoss JC2017Sakran JV2017Poon SHT2017Ehlers AP2016Talutis SD2017Kessler U2017Horst JA2015Huang L2017Kirby A2015Xu J2017Findlay JM2016Georgiou R2017Gorter RR2017
10 Referencias ( articles) loading Revertir Estudificar

Revisión sistemática

No clasificado

Revisión sistemática del tratamiento no quirúrgico versus tratamiento quirúrgico de la apendicitis no complicada.

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Revista Journal of pediatric surgery
Año 2017
Enlaces Pubmed DOI
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Antecedentes: Comparar el riesgo de complicaciones entre el tratamiento inicial no quirúrgico y la apendicectomía de apendicitis no complicada (simple) en niños. MÉTODOS: Búsqueda sistemática de literatura. Elegibles para la inclusión fueron ambos y ensayos controlados aleatorios y estudios de cohortes incluyendo niños en los que se informó el resultado del tratamiento no operatorio de la apendicitis sin complicaciones con un período mínimo de seguimiento de un año. Dos autores extrajeron los datos de forma independiente y evaluaron la calidad. El parámetro de resultado primario fue el porcentaje de niños con complicaciones. Los resultados secundarios fueron fracasos tempranos, apendicitis recurrente y apendicectomías, para todas las indicaciones y bajo demanda. RESULTADOS: Cinco de los 2051 artículos seleccionados fueron elegibles para la inclusión, incluyendo 147 niños (tratamiento no operatorio) y 173 niños (apendicectomía) con un seguimiento de un año. El porcentaje de niños que experimentaron complicaciones varió de 0 a 13% versus 0-17% para no operatorio y apendicectomía, respectivamente. El tratamiento no quirúrgico evitó una apendicectomía en el 62-81% de los niños después de un año de seguimiento. CONCLUSIÓN: La base de evidencia para el tratamiento inicial no operatorio de apendicitis aguda no complicada en niños es por lejos insuficiente. Sugiere que el porcentaje de pacientes con complicaciones en el grupo de tratamiento inicial no operatorio es comparable al grupo de la apendicectomía y puede evitar una apendicectomía en la gran mayoría de los niños después de un año de seguimiento. TIPO DE ESTUDIO: Revisión sistemática. NIVEL DE EVIDENCIA: 1.

Estudio primario

No clasificado

Antibiotics alone as an alternative therapy for uncomplicated pediatric appendicitis

Revista Journal of the American College of Surgeons
Año 2014
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Revisión sistemática

No clasificado

Efficacy and Safety of Nonoperative Treatment for Acute Appendicitis: A Meta-analysis.

Revista Pediatrics
Año 2017
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CONTEXT: Nonoperative treatment (NOT) with antibiotics alone of acute uncomplicated appendicitis (AUA) in children has been proposed as an alternative to appendectomy. OBJECTIVE: To determine safety and efficacy of NOT based on current literature. DATA SOURCES: Three electronic databases. STUDY SELECTION: All articles reporting NOT for AUA in children. DATA EXTRACTION: Two reviewers independently verified study inclusion and extracted data. RESULTS: Ten articles reporting 413 children receiving NOT were included. Six, including 1 randomized controlled trial, compared NOT with appendectomy. The remaining 4 reported outcomes of children receiving NOT without a comparison group. NOT was effective as the initial treatment in 97% of children (95% confidence interval [CI] 96% to 99%). Initial length of hospital stay was shorter in children treated with appendectomy compared with NOT (mean difference 0.5 days [95% CI 0.2 to 0.8]; P = .002). At final reported follow-up (range 8 weeks to 4 years), NOT remained effective (no appendectomy performed) in 82% of children (95% CI 77% to 87%). Recurrent appendicitis occurred in 14% (95% CI 7% to 21%). Complications and total length of hospital stay during follow-up were similar for NOT and appendectomy. No serious adverse events related to NOT were reported. LIMITATIONS: The lack of prospective randomized studies limits definitive conclusions to influence clinical practice. CONCLUSIONS: Current data suggest that NOT is safe. It appears effective as initial treatment in 97% of children with AUA, and the rate of recurrent appendicitis is 14%. Longer-term clinical outcomes and cost-effectiveness of NOT compared with appendicectomy require further evaluation, preferably in large randomized trials, to reliably inform decision-making.

Revisión sistemática

No clasificado

Nonoperative Management of Appendicitis in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Revista Journal of the American College of Surgeons
Año 2016
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Estudio primario

No clasificado

Conservative treatment in acute appendicitis.

Revista JNMA; journal of the Nepal Medical Association
Año 2010
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INTRODUCTION: Acute appendicitis is one of the commonest surgical problems and appendectomy is one of the most commonly done operations in the emergency world wide. Though there have been occasional reports with conservative treatment in acute appendicitis, it is not being practiced as a routine. METHODS: All patients between ten to sixty years of age admitted at BPKIHS with the diagnosis of acute appendicitis over a period of one year were enrolled in the study. After taking informed consent the patients were managed conservatively. Those who did not respond to antibiotics within 24 hours were operated. Total hospital stay and complications were recorded and they were followed up at first week, sixth week and sixth month. The success rate, conversion rate, recurrence rate and morbidity and mortality pattern were assessed as the final outcome of conservative treatment of acute appendicitis. RESULTS: A total of 96 patients (48 males and 48 females) underwent conservative treatment. The conservative treatment was successful in 79 (82.3%) cases and failed in 11 (11.4%) cases, which included: conversion to appendectomy during conservative treatment period 4 (4.2%) cases, recurrence 7 (7.3%) cases. There was no mortality in this study. CONCLUSION: Acute appendicitis can be treated successfully with conservative (antibiotics) treatment with a short hospital stay. Though there is a risk of recurrence in some cases, all the complications after appendectomy can be eliminated with the conservative treatment.

Estudio primario

No clasificado

Intraluminal appendiceal fluid is a predictive factor for recurrent appendicitis after initial successful non-operative management of uncomplicated appendicitis in pediatric patients.

Revista Journal of pediatric surgery
Año 2014
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BACKGROUND: The risk factors for recurrent appendicitis in pediatric patients are unclear. This study aimed to identify the predictive factors for recurrent appendicitis in pediatric patients who initially underwent successful non-operative management of uncomplicated appendicitis. METHODS: Potential predictive factors for recurrent appendicitis in terms of clinical characteristics, laboratory data, and abdominal ultrasonography and computed tomography findings, were evaluated. RESULTS: This study included 125 patients who underwent initial successful non-operative management of appendicitis. The rate of recurrent appendicitis was 19.2%, and the mean time to recurrence was 12.6 months. Univariate analyses found that rebound tenderness, muscle guarding, appendicoliths, appendiceal diameter >9 mm, and intraluminal appendiceal fluid were associated with recurrent appendicitis. Multivariate analysis identified only intraluminal appendiceal fluid as an independent predictor of recurrent appendicitis. CONCLUSIONS: Intraluminal appendiceal fluid is a predictive factor for recurrent appendicitis after initial non-operative management. The results of this study provide valuable information that may help to determine the appropriate management during the first episode of appendicitis.

Estudio primario

No clasificado

Efficacy of short-term antibiotic therapy for consecutive patients with mild appendicitis.

Autores Park HC , Kim BS , Lee BH
Revista The American surgeon
Año 2011
Enlaces Pubmed
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Although antibiotic therapy seemed to be a safe treatment option for acute appendicitis, indications of this treatment have not been fully evaluated. We hypothesized that clinical and radiologic mild appendicitis may be a candidate for short-term antibiotic therapy. The purpose of present study was to examine the efficacy and the recurrence rate of short-term antibiotic therapy for consecutive patients with mild appendicitis. A prospective observational study was conducted over 3 years. The mild appendicitis was defined as the intermediate Alvarado score (4-8) and dilated appendix from 6 mm to 10 mm in radiologic study. All patients received initial antibiotics administration with clinical observation during 48 hours. The failure to respond to therapy and the incidence of recurrence were assessed. There were 107 enrolled patients with the mean Alvarado score of 6 ± 1 and the mean appendiceal diameter of 7.4 ± 1 mm. Of these, 97 (91%) exhibited improved symptoms and were discharged. The remaining 10 patients underwent surgery because of clinical aggravation, and pathology revealed true appendicitis in six of them. Of the 97 patients in whom the initial treatment was successful, five patients (5%) exhibited recurrent symptoms during a median follow-up period of 18 months. Of these five patients, three were treated with surgery (all true appendicitis), and the remaining two were once again treated with antibiotics. Patients with suspected appendicitis, those in whom mild appendicitis was diagnosed after clinical and radiologic evaluations, were found to benefit from short-term antibiotic therapy.

Estudio primario

No clasificado

Acute appendicitis in children: not only surgical treatment.

Revista Journal of pediatric surgery
Año 2017
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PURPOSE: An accurate diagnosis of acute appendicitis is important to avoid severe outcome or unnecessary surgery but management is controversial. The aim of study was to evaluate, in younger and older children, the efficacy of conservative management for uncomplicated appendicitis and the outcome of complicated forms underwent early surgery. METHODS: Children with acute appendicitis were investigated by clinical, laboratory variables and abdominal ultrasound and divided in two groups: complicated and uncomplicated. Complicated appendicitis underwent early surgery; uncomplicated appendicitis started conservative treatment with antibiotic. If in the next 24-48h it was worsening, the conservative approach failed and patients underwent late surgery. RESULTS: A total of 362 pediatric patients were included. One hundred sixty-five underwent early appendectomy; 197 patients were at first treated conservatively: of these, 82 were operated within 24-48h for failure. The total percentage of operated patients was 68.2%. An elevated association was found between surgery and ultrasound. CONCLUSIONS: Conservative treatment for uncomplicated appendicitis had high percentage of success (58%). Complications in operated patients were infrequent. Our protocol was effective in order to decide which patients treat early surgically and which conservatively; specific red flags (age and onset) can identified patients at most risk of complications or conservative failure. TYPE OF STUDY: treatment study. LEVEL OF EVIDENCE: II.

Estudio primario

No clasificado

A role for conservative antibiotic treatment in early appendicitis in children.

Revista Journal of pediatric surgery
Año 2015
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PURPOSE: To evaluate whether antibiotics without surgery is sufficient treatment for children with clinically and ultrasonographically suspected acute appendicitis (AA). METHOD: Children with clinical, laboratory and radiological findings suspicious for AA were evaluated prospectively. Patients with mild clinical signs, without peritonitis were considered for IV followed by oral antibiotics without surgery. RESULTS: From 1 November 2013 through 30 June 2014, 45 children were diagnosed with early, acute appendicitis. Ages ranged from 4 to 15 years (mean 9.3) and 32 (75%) were boys. All had routine, clinical laboratory and ultrasound workup. Forty-two improved with antibiotic treatment and were discharged home within 3-5 days, without surgery. Three of them were operated on within 24 hours, another two underwent appendectomy for recurrent appendicitis: one at 2 weeks and the other 2 months after discharge. There was no more recurrent appendicitis in 6-14-month follow-up. CONCLUSION: Our series of patients with AA treated with antibiotics only are a product of the observation that some children improve with antibiotics alone at a stage in which surgery is still debatable. These results (89% success rate) support the conservative approach in cases of early appendicitis, without increased morbidity in failed cases.

Revisión sistemática

No clasificado

Exactitud del punto de atención Ultrasonografía para el diagnóstico de la apendicitis aguda: una revisión sistemática y metanálisis.

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Revista Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
Año 2017
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INTRODUCCIÓN: El uso de la ecografía para diagnosticar la apendicitis se ha vuelto cada vez más común en los últimos años y está bien establecido. Más recientemente, también se ha estudiado la ecografía de punto de atención (POCUS) para el diagnóstico de apendicitis, que también puede ser una valiosa herramienta diagnóstica. El propósito de este estudio es a través de revisión sistemática y meta-análisis para identificar las características de la prueba de POCUS, específicamente ecografía realizadas por un médico no radiólogo, en el diagnóstico de precisión apendicitis aguda en pacientes de cualquier edad. Métodos: Se realizó una búsqueda bibliográfica exhaustiva y sistemática de los artículos publicados en inglés sobre el punto de atención, la ecografía transabdominal médico realizado utilizada para el diagnóstico de apendicitis aguda de 1980 a mayo de 2015 mediante OVID (®) Medline, en proceso, y Otras citas no indexadas; Y SCOPUS. Los estudios fueron seleccionados y posteriormente extraídos de forma independiente por dos revisores capacitados. Se utilizó un análisis agrupado de efectos aleatorios para construir una curva característica de receptor-operador de resumen jerárquico y se realizó una meta-regresión. La calidad de los estudios se evaluó mediante la herramienta QUADAS-2. RESULTADOS: Nuestra búsqueda arrojó 5.792 estudios únicos e incluimos 21 de ellos en nuestra revisión final. La prevalencia de enfermedad en este estudio fue de 29,8%, (rango, 6,4% -75,4%). La sensibilidad y especificidad de POCUS en el diagnóstico de la apendicitis fue de 91% (IC del 95%, 83% -96%) y 97% (IC del 95%, 91% -99%), respectivamente. Los valores predictivos positivos y negativos fueron 91% y 94%, respectivamente. Los estudios realizados por médicos de urgencia tuvieron características de prueba ligeramente más bajas (sensibilidad = 80%, especificidad = 92%). Hubo una heterogeneidad significativa entre los estudios (I (2) = 99%, IC del 95%, 99-100%) y la calidad de los estudios reportados fue moderada, debido principalmente a informes poco claros sobre el cegamiento de los médicos y el momento del escaneo y la inscripción del paciente . Varios de los estudios fueron realizados por un solo operador, y la educación y capacitación de los operadores se informó de manera variable. CONCLUSIÓN: El POCUS tiene una sensibilidad y especificidad relativamente alta para diagnosticar la apendicitis aguda, aunque los datos presentados están limitados por la calidad de los estudios originales y los grandes intervalos de confianza. En manos de un operador experimentado, POCUS es una modalidad de imagen inicial apropiada para diagnosticar la apendicitis. Sobre la base de nuestros resultados, es prematuro utilizar POCUS como una prueba independiente o para descartar la apendicitis. Este artículo está protegido por derechos de autor. Todos los derechos reservados.
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