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HEMORRAGIA SUPRATENTORIAL ESPONTANEA: UN MODELO MATEMATICO PREDICTIVO DE MORTALIDAD

HEMORRAGIA SUPRATENTORIAL ESPONTANEA: UN MODELO MATEMATICO PREDICTIVO DE MORTALIDAD

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Estudio prospectivo realizado en las Unidades de Terapia Intensiva del Hospital General Manuel Belgrano y del Policlínico Central de la Unión Obrera Metalúrgica, Buenos Aires, Argentina.
Autor:
Fernando Racca Velásquez
Columnista Experta de SIIC

Institución:
Hospital Zonal de Agudos General Manuel Belgrano


Artículos publicados por Fernando Racca Velásquez
Coautores
Adolfo Eduardo Alsina* Fernando Racca Velásquez* 
Médico, Hospital Zonal de Agudos General Manuel Belgrano, San Martín, Argentina*
Recepción del artículo
10 de Enero, 2014
Aprobación
25 de Febrero, 2014
Primera edición
20 de Marzo, 2014
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
Objetivo: Plantear un modelo matemático predictivo de mortalidad para la hemorragia supratentorial espontánea. Material y métodos: Se efectuó un estudio prospectivo en las unidades de Terapia Intensiva del Hospital General Manuel Belgrano y el Policlínico Central de la Unión Obrera Metalúrgica (Buenos Aires, Argentina). Se evaluó la localización de la hemorragia, el volumen del hematoma (V), la presencia de volcado ventricular (VV) y la desviación de la línea media (DLM). Resultados: El análisis mostró que el volumen del hematoma, la desviación de la línea media y la presencia de volcado ventricular se comportaron como factores predictivos independientes de mortalidad. Por el método de regresión logística múltiple se demuestra que el volcado ventricular incrementa el riesgo de mortalidad en 3.1 veces. Por cada centímetro cúbico de aumento del volumen del hematoma se incrementa la mortalidad un 6.2%, y por cada milímetro de desviación de la línea media la probabilidad de mortalidad se incrementa en 32.8%. Este modelo demuestra tener una sensibilidad del 79.8% y una especificidad del 95.2%. El rango de clasificación correcta es del 89%. El logit del modelo fue: -4.948 + 1.415 (VV) + 0.06 (V) + 0.248 (DLM). Conclusiones: En la población en estudio fue posible plantear un modelo matemático de probabilidad con alta sensibilidad y especificidad.

Palabras clave
hemorragia intracerebral, hemorragia supratentorial, pronóstico, modelo estadístico, tomografía computarizada


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Abstract
Background: The aim of this study was to assess the predictive value of a CT scan score in spontaneous supratentorial hemorrhage. Materials and methods: A prospective study took place in intensive care units at the General Belgrano Hospital and at the Central Clinic of the Metal Workers Trade Union (Buenos Aires, Argentina). The location of the hemorrhage, the volume of the hematoma (HV), the midline shift (MLS) and the presence of intraventricular hemorrhage (IVH) were evaluated. Results: By using multiple logistic regression analysis in a mathematical mortality probability model, hematoma volume, midline shift and intraventricular hemorrhage behaved as independent predictive factors of mortality. Each ml increase in hematoma volume increases mortality by 6.2%. Intraventricular hemorrhage shows a threefold increase in mortality, and for every mm of midline shift the probability rises by 32.8%. The model showed a sensibility of 79.8% and a specificity of 95.2%. Model logit was as follows: -4.948 + 1.415 (IVH) + 0.06 (V) + 0.248 (MLS). Conclusion: In the study population it was possible to apply a mathematical model of probability with high specificity and sensibility.

Key words
intracerebral hemorrhage, supratentorial hemorrhage, prognosis, statistical model, computed tomography


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Cuidados Intensivos, Neurocirugía
Relacionadas: Diagnóstico por Imágenes, Emergentología, Informática Biomédica, Neurología



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Fernando Racca Velásquez, 1406, Jose Bonifacio 1748 6º "A", Ciudad Autónoma de Buenos Aire, Argentina
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