SciELO - Scientific Electronic Library Online

 
vol.137 issue6Maternal exposure to benzene and toluene and preterm birth. A longitudinal studyHospitalization costs and their determining factors among patients undergoing kidney transplantation: a cross-sectional descriptive study author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

Share


Sao Paulo Medical Journal

Print version ISSN 1516-3180On-line version ISSN 1806-9460

Abstract

SOARES, Pedro França da Costa et al. Epidemiological profile, referral routes and diagnostic accuracy of cases of acute cholangitis among individuals with obstructive jaundice admitted to a tertiary-level university hospital: a cross-sectional study. Sao Paulo Med. J. [online]. 2019, vol.137, n.6, pp.491-497.  Epub Mar 06, 2020. ISSN 1806-9460.  https://doi.org/10.1590/1516-3180.2019.0109170919.

BACKGROUND:

Obstructive jaundice may lead to ominous complications and requires complex diagnostic evaluations and therapies that are not widely available.

OBJECTIVE:

To analyze the epidemiological profile, referral routes and diagnostic accuracy at admittance of cases of acute cholangitis among patients with obstructive jaundice treated at a referral unit.

DESIGN AND SETTING:

Cross-sectional study at a tertiary-level university hospital.

METHODS:

Patients with obstructive jaundice who were treated by means of endoscopic retrograde cholangiopancreatography, resection and/or surgical biliary drainage were evaluated. The main variables analyzed were epidemiological data, referral route, bilirubin levels and time elapsed between symptom onset and admittance and diagnosing of acute cholangitis at the referral unit. The accuracy of the clinical diagnosis of acute cholangitis was compared with a retrospective analysis on the medical records in accordance with the Tokyo criteria.

RESULTS:

Female patients predominated (58%), with an average age of 56 years. Acute cholangitis was detected in 9.9% of the individuals; application of the Tokyo criteria showed that the real prevalence was approximately 43%. The main referral route was direct contact (31.8%) and emergency care (29.7%); routing via official referral through the public healthcare system accounted for 17.6%, and internal referral from other specialties, 20%. The direct route with unofficial referral was the most important route for cases of neoplastic etiology (P < 0.01) and was the fastest route (P < 0.01).

CONCLUSIONS:

There is a deficiency in the official referral routes for patients with obstructive jaundice. The accuracy of the clinical diagnosis of acute cholangitis was poor. Wider dissemination of the Tokyo criteria is essential.

Keywords : Bile ducts; Jaundice; Cholangitis; Referral and consultation; Tertiary care centers; Cholestasis; Biliary obstruction; Public health system; Obstructive jaundice; Main bile duct stones; Periampullary neoplasms.

        · text in English     · English ( pdf )