<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1405-0099</journal-id>
<journal-title><![CDATA[Cirujano general]]></journal-title>
<abbrev-journal-title><![CDATA[Cir. gen]]></abbrev-journal-title>
<issn>1405-0099</issn>
<publisher>
<publisher-name><![CDATA[Asociación Mexicana de Cirugía General A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1405-00992015000100032</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Exploración física del abdomen agudo y sus principales signos como una práctica basada en la evidencia]]></article-title>
<article-title xml:lang="en"><![CDATA[Physical exam of acute abdomen and its main signs as an evidence-based practice]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rungs Brown]]></surname>
<given-names><![CDATA[David R de]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Víctor Baldin]]></surname>
<given-names><![CDATA[André]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Muñoz Hinojosa]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Valdés Castañeda]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gómez Palacio]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Ángeles Lomas Departamento de Cirugía General ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2015</year>
</pub-date>
<volume>37</volume>
<numero>1-2</numero>
<fpage>32</fpage>
<lpage>37</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S1405-00992015000100032&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S1405-00992015000100032&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S1405-00992015000100032&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción:  La medicina basada en la evidencia combina la mejor prueba científica disponible junto con el juicio clínico para tomar decisiones médicas. El retorno al ritual de la exploración física y actualizarlo a la medicina basada en evidencia son de gran importancia en esta etapa de la medicina tecnológica.  Material y métodos:  Se realizó un estudio comparativo de tipo metaanálisis de investigación educativa utilizando ocho bases de datos, buscando artículos de los últimos 30 años (1982-2012). De 50 artículos seleccionados, se pusieron a prueba para la homogeneidad de los datos mediante el uso de la estadística de prueba odds ratio de Breslow-Day. Los estudios se combinaron y los valores predictivos positivo y negativo fueron calculados mediante la prueba Cochran-Mantel-Haenszel.  Resultados:  Las tres principales causas de dolor abdominal agudo en el Servicio de Urgencias (n = 12,706) fueron apendicitis, colecistitis y oclusión intestinal, incluyendo los principales signos encontrados en abdomen agudo con alguna patología crónica digestiva. Apendicitis (n = 9,478): dolor abdominal y el signo de Von Blumberg, valor predictivo positivo (VPP) de 7.9 (7.3 a 8.5), punto de McBurney con VPP de 4.2 (1.1-6.3). Colecistitis (n = 5,716): signo Murphy positivo con VPP de 2.8 (0.8-8.6), rigidez abdominal con VPP de 1.6 (1.0-2.5). Oclusión intestinal (n = 2,275): peristalsis visible con VPP de 9.5 (16.3 a 22.4) y distensión abdominal con VPP de 6.3 (09.03 a 12.03). Exploración abdominal para hepatopatía crónica (n = 3,134): signo de ola para encontrar ascitis libres con VPP 6 (3.3 a 11.0), la palpación para la búsqueda de esplenomegalia con el paciente en decúbito supino con VPP de 8.2 (5.8-12) y hepatomegalia palpable en el borde hepático con VPP de 2 (1.5-2.8).  Conclusión:  Desde el inicio de la semiología, para llegar a un diagnóstico pertinente, la exploración física siempre es fundamental. Las tres principales patologías pueden tener su diagnóstico presuntivo realizando el examen adecuado del paciente, lo que demuestra que la medicina basada en la evidencia y el ritual de la exploración física es el mejor método diagnóstico.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  Evidence-based medicine combines the best scientific evidence available and clinical judgment in order to make medical decisions. The return to the ritual of the physical examination and its upgrading to evidence-based medicine are important in this age of technological medicine.  Methods:  A comparative meta-analysis was performed using eight databases, searching for articles in the past 50 years. A total of 90 articles were selected, which were then tested for homogeneity of data by using the odds ratio Breslow-Day statistic test. The studies found were combined and positive and negative predictive values &#8203;&#8203;were calculated using the Cochran-Mantel-Haenszel test.  Results:  The three main causes of acute abdominal pain in the emergency department (n = 12,706), were determined as appendicitis, cholecystitis and intestinal occlusion, including the primary signs found in acute abdomen with a chronic digestive disease. Appendicitis (n = 9,478): right lower quadrant pain with a positive predictive value (PPV) of 7.9 (7.3-8.5), and Von Blumberg sign, McBurney&#8217;s point with a PPV of 4.2 (1.1-6.3). Cholecystitis (n = 5,716): positive Murphy sign with a PPV of 2.8 (0.8-8.6), and abdominal rigidity with a PPV of 1.6 (1.0-2.5). Intestinal occlusion (n = 2,275): visible peristalsis with a PPV of 9.5 (16.3-22.4), and abdominal distension with a PPV of 6.3 (9.3-12.3). Abdominal exploration in chronic liver diseases (n= 3,134): wave sign for finding free ascites with a PPV of 6 (3.3-11.0), palpation with the patient supine in the search of a splenomegaly with a PPV of 8.2 (5.8-12), and search for palpable hepatomegaly in the liver edge with a PPV of 2 (1.5-2.8).  Conclusion:  Physical examination has always been essential to reach an appropriate diagnosis since the beginning of semiotics. The three main pathologies detected in this study can have their presumptive diagnosis through an appropriate examination of the patient, demonstrating that evidence-based medicine and the ritual of the physical examination are the best diagnostic examination method.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Medicina basada en la evidencia]]></kwd>
<kwd lng="es"><![CDATA[exploración física]]></kwd>
<kwd lng="es"><![CDATA[diagnóstico]]></kwd>
<kwd lng="es"><![CDATA[semiología]]></kwd>
<kwd lng="es"><![CDATA[prueba científica]]></kwd>
<kwd lng="en"><![CDATA[Evidence-based medicine]]></kwd>
<kwd lng="en"><![CDATA[physical examination]]></kwd>
<kwd lng="en"><![CDATA[diagnosis]]></kwd>
<kwd lng="en"><![CDATA[semiology]]></kwd>
<kwd lng="en"><![CDATA[scientific proof]]></kwd>
</kwd-group>
</article-meta>
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