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  • Title: [Validity of the abdominal ecography in primary care for detection of aorta abdominal aneurism in male between 65 and 75 years].
    Author: Bravo-Merino L, González-Lozano N, Maroto-Salmón R, Meijide-Santos G, Suárez-Gil P, Fañanás-Mastral A.
    Journal: Aten Primaria; 2019 Jan; 51(1):11-17. PubMed ID: 29225000.
    Abstract:
    OBJECTIVE: To determine the usefulness of ultrasound examination in Primary Care (PC) for the detection of abdominal aortic aneurysm (AAA) in male patients from 65-75 years old, as well as the consistency between observers on the diagnosis between general practitioners and the reference specialty in this area, Vascular Surgery. To estimate the prevalence of AAA in that population and its association with risk factors. DESIGN: Cross-sectional descriptive study. LOCATION: Healthcare Centres of Coto and Calzada II (Gijón, Spain). PARTICIPANTS: Males born between 1 January 1939 and 31 December 1950. INTERVENTIONS: From the 2,511 males found, 407 were selected using stratified random sampling. Aortic diameter was measured, with those ≥3cm and 20% from the <3cm being referred for a second measurement by a vascular surgeon. VARIABLES: Dependent: presence/absence of aneurism. Independent: age, abdominal perimeter, smoking, arterial hypertension, diabetes, dyslipidaemia, familial cases of AAA, cerebrovascular accident, and coronary disease. The analysis was performed using Bayesian inference with models for proportions and a multivariate logistic regression. RESULTS: From 304 ultrasound scans performed, 13 were referred with suspicion of AAA, and 63 with were within normal. The sensitivity was 93.3% and specificity 98.5% with a 95% credibility interval (CredI) of 75.4-99.9%, and 94.3-100%, respectively. The prevalence was 4.6% (95% CredI: 2.5-7.2%, and the intraclass correlation coefficient between PC and Vascular Surgery was 0.88 (95% CredI: 0.79-0.94). Age, smoking, dyslipidaemia, and diabetes tended to increase the odds of prevalence of AAA. CONCLUSION: The ultrasound performed by GPs for the detection of AAA had high diagnostic validity. Further studies on the effectiveness should be conducted in order to assess the appropriateness of introducing a system of early detection of AAA in the risk population. OBJETIVOS: Determinar la validez de la ecografía en Atención Primaria (AP) para detección de aneurisma de aorta abdominal (AAA) en varones de 65 a 75 años y la concordancia interobservador en el diagnóstico entre médicos de AP y el referente del área (Cirugía Vascular). Estimar la prevalencia de AAA en dicha población y su relación con factores de riesgo. DISEÑO: Estudio descriptivo transversal. EMPLAZAMIENTO: Centros de Salud Coto y Calzada II (Gijón). PARTICIPANTES: Varones nacidos entre el 1/1/1939 y el 31/12/1950. INTERVENCIÓN: De 2.511 varones se seleccionaron 407 mediante muestreo aleatorizado estratificado. Se realizó medición ecográfica del diámetro aórtico. Se derivaron para segunda medida en Cirugía Vascular a aquellos con ≥3 cm y un 20% de los <3 cm. VARIABLES: Dependiente: presencia/ausencia de aneurisma; independientes: edad, perímetro abdominal, tabaco, hipertensión arterial, diabetes, dislipidemia, antecedentes familiares de AAA, accidente cerebrovascular y enfermedad coronaria. Análisis estadístico: inferencia bayesiana con modelos para proporciones y regresión logística multivariante. RESULTADOS: De 304 ecografías realizadas, fueron derivados 13 sujetos con sospecha de AAA y 63 con ecografía normal. Se obtuvo una sensibilidad del 93,3% y una especificidad del 98,5% con intervalo de credibilidad (ICred) del 95% (75,4-99,9% y 94,3-100%), respectivamente; una prevalencia del 4,6% (ICred95%: 2,5-7,2%) y coeficiente de correlación intraclase entre AP y Cirugía Vascular de 0,88 (ICred95%: 0,79-0,94). Edad, tabaco, hipertensión, dislipidemia y diabetes mostraron incrementar de forma relevante la odds de prevalencia de AAA. CONCLUSIONES: La ecografía en AP realizada por médicos de familia tras una formación básica para detección de AAA muestra muy alta validez diagnóstica. Habría que valorar con estudios más amplios de efectividad la pertinencia de implantar un sistema de detección precoz de AAA en población de riesgo.
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