Resumo: Esse artigo buscou investigar as características dos pacientes atendidos com dor abdominal aguda (DAA) em um serviço de Tomografia Computadorizada (CT) e sua relação com os diagnósticos mais frequentes. Sabe-se que o Brasil não possui um sistema de informação sobre as características clínicas e epidemiológicas dos pacientes com DAA atendidos nos serviços de urgência. A sensibilidade da história clínica, exame físico e dos dados laboratoriais são altos para a diferenciação entre causas urgentes ou não, mas insuficiente para o diagnóstico específico. As características clínicas, laboratoriais e de imagem variaram conforme o sexo e a idade dos pacientes interferindo nos diagnósticos iniciais e finais após a realização da TC. Com isso, a TC influencia a tomada de decisão na urgência e emergência levando a mudanças no diagnóstico principal, sendo um método de imagem útil na caracterização etiológica. Porém, há necessidade de aliar com a anamnese e exame físico na suspeita diagnóstica, considerando a idade e sexo dos pacientes.

The number of computed tomography (CT) examinations performed in urgent care has been increasing since its introduction in the emergency room (ER). This has led to a substantial increase in hospital costs and patient’s exposure to ionizing radiation, which has led to the need for more judicious use of CT in the ER. The aim of this study is to show the difference between clinical (pre-CT), tomographic (post-CT) and definitive diagnoses in patients with abdominal CT in the ER. This is a cross-sectional study, with retrospective data collection through electronic medical records. A total of 834 patients with acute abdominal pain (AAP) lasting less than 7 days, submitted to abdominal computed tomography between January 1, 2016 and December 31, 2017 were selected. Clinical, tomographic and final diagnoses were recorded and submitted to a concordance analysis by calculating the Kappa coefficient, considering p <0.05 as significant. CT scans were considered unnecessary when the clinical diagnosis was concordant when both final and post-CT diagnosis were also concordant. The most frequent diagnoses were nonspecific abdominal pain (NSAP), obstructive uropathy (OU) and appendicitis (AP), corresponding to 73.6%, 58.5% and 61.3% of all diagnoses, respectively. Data analysis showed a moderate Concordance for NSAP (kappa: 0.41, p ¬<0.001) and for OU (kappa: 0.46, p <0.001) and excellent for AP (kappa:0.87, p <0.001). In total, 52.6% of computed tomography were considered unnecessary for NSAP, 82.4% for OU and 91.7% for AP. It was concluded that there are high rates of CT that may be considered unnecessary for the diagnosis of the main emergency conditions, especially appendicitis. The study warns to the exaggerated use of CT in the ER and raise discussions over the possible causes, such as lack of confidence in the clinical diagnosis, fear of diagnostic errors and fear of malpractice lawsuits, of which possible solutions may be more effective when applied since the medical education basis.

RESUMO: O estudo teve como objetivo analisar as características clínicas, laboratoriais e de imagem associadas à tomografia computadorizada sem diagnóstico específico para dor abdominal aguda. Trata-se de um estudo observacional e transversal, baseado em revisão de prontuários de pacientes com dor abdominal aguda não traumática, submetidos a tomografia computadorizada de abdome de urgência. Foram coletadas variáveis clínicas do atendimento inicial, resultados de tomografia computadorizada e o diagnóstico final.

A violência contra crianças e adolescentes é um problema mundial de saúde pública. A cada 7 minutos, uma criança e adolescente é vítima de violência no mundo. Estudos internacionais indicaram que 91% das mortes por armas de fogo de crianças entre 0 e 14 anos ocorrem nos Estados Unidos em relação aos outros países de renda alta. Sergipe, Rio Grande do Norte e Alagoas tiveram maior índice de violência em 2016. O objetivo deste estudo foi estabelecer o perfil dos óbitos por agressão em crianças e adolescentes no estado de Sergipe. Trata-se de um estudo de coorte, de caráter descritivo e analítico com abordagem quantitativa, realizado por meio de coleta de dados nos 75 municípios do estado de Sergipe. As informações foram obtidas a partir do banco de dados do Ministério da Saúde, no Departamento de Informática do Sistema Único de Saúde e no Sistema de Informação sobre Mortalidade. Dos 2910 (100%) registros de mortes de crianças e adolescentes entre 0 e 18 anos no recorte temporal de 2007 a 2016, foi observado que (60,1%) das ocorrências acometeram adolescentes entre 17 e 18 anos, (92,4%) do sexo masculino, (87,3%) cor/raça parda, (2%) estado civil casado, com 4 a 7 anos de estudo, (53,0%) das agressões ocorreram na região de saúde Aracaju, (54,3%) no período noturno, sendo que (84,5%) foram por arma de fogo. A agressão destaca-se com magnitude e prevalência de ocorrência dos casos de óbitos e o adolescente apresenta-se como principal vítima.

The number of computed tomography (CT) examinations performed in urgent care has been increasing since its introduction in the emergency room (ER). This has led to a substantial increase in hospital costs and patient’s exposure to ionizing radiation, which has led to the need for more judicious use of CT in the ER. The aim of this study is to show the difference between clinical (pre-CT), tomographic (post-CT) and definitive diagnoses in patients with abdominal CT in the ER. This is a cross-sectional study, with retrospective data collection through electronic medical records. A total of 834 patients with acute abdominal pain (AAP) lasting less than 7 days, submitted to abdominal computed tomography between January 1, 2016 and December 31, 2017 were selected. Clinical, tomographic and final diagnoses were recorded and submitted to a concordance analysis by calculating the Kappa coefficient, considering p <0.05 as significant. CT scans were considered unnecessary when the clinical diagnosis was concordant when both final and post-CT diagnosis were also concordant. The most frequent diagnoses were nonspecific abdominal pain (NSAP), obstructive uropathy (OU) and appendicitis (AP), corresponding to 73.6%, 58.5% and 61.3% of all diagnoses, respectively. Data analysis showed a moderate Concordance for NSAP (kappa: 0.41, p ¬<0.001) and for OU (kappa: 0.46, p <0.001) and excellent for AP (kappa:0.87, p <0.001). In total, 52.6% of computed tomography were considered unnecessary for NSAP, 82.4% for OU and 91.7% for AP. It was concluded that there are high rates of CT that may be considered unnecessary for the diagnosis of the main emergency conditions, especially appendicitis. The study warns to the exaggerated use of CT in the ER and raise discussions over the possible causes, such as lack of confidence in the clinical diagnosis, fear of diagnostic errors and fear of malpractice lawsuits, of which possible solutions may be more effective when applied since the medical education basis.