Originales
Validación del signo de palidez palmar para diagnóstico de anemia en niños de Bucaramanga (Colombia)
Validation of the palmar pallor sign in the diagnosis of anemia in children in bucaramanga (Colombia)
J. Cala Vecinoa, J.F. Latorre Latorrea,b,c,
, O.L. Segovia Moralesa,c, R. Méndez Serranoa, C. Sandoval Gómeza,b
Corresponding author
jlatorre@bumanga.unab.edu.co
Correspondencia: Dr. J.F. Latorre Latorre. Universidad Autónoma de Bucaramanga. Facultad de Medicina. Campus el Bosque.Calle 48, 39-234. Bucaramanga. Colombia.
Correspondencia: Dr. J.F. Latorre Latorre. Universidad Autónoma de Bucaramanga. Facultad de Medicina. Campus el Bosque.Calle 48, 39-234. Bucaramanga. Colombia.
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"apellidos" => "Cala Vecino" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 1 => array:4 [ "nombre" => "J.F." "apellidos" => "Latorre Latorre" "email" => array:1 [ 0 => "jlatorre@bumanga.unab.edu.co" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 2 => array:3 [ "nombre" => "O.L." 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Colombia" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Línea de Epidemiología UNAB. Colombia" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Departamento de Pediatría Universidad Industrialde Santander. Colombia" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: Dr. J.F. Latorre Latorre. Universidad Autónoma de Bucaramanga. Facultad de Medicina. Campus el Bosque.Calle 48, 39-234. Bucaramanga. Colombia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Validation of the palmar pallor sign in the diagnosis of anemia in children in bucaramanga (Colombia)" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2004-10-31" "fechaAceptado" => "2005-07-31" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec186269" "palabras" => array:5 [ 0 => "Niños" 1 => "Palidez palmar" 2 => "Anemia" 3 => "Validación" 4 => "Pruebas diagnósticas" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec186270" "palabras" => array:5 [ 0 => "Children" 1 => "Palmar pallor" 2 => "Anemia" 3 => "Validity" 4 => "Diagnostic tests" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Antecedentes</span><p class="elsevierStyleSimplePara elsevierViewall">La prevalencia de anemia en niños de Santander (Colombia),está cercana al 28 %, pero las condiciones económicas dificultan la realización de hemoglobina en todos los niños sospechosos de padecerla. El signo de palidez palmar ha sido recomendado por la Organización Mundial de Salud (OMS) y Organización Panamericana de Salud (OPS) para el diagnóstico de anemia en menores de 5 años; sin embargo, el rendimiento de la prueba no se ha establecido en poblaciones de nuestro país. Los objetivos del estudio fueron establecer el rendimiento de dicha prueba y determiner su reproducibilidad.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p class="elsevierStyleSimplePara elsevierViewall">El signo de palidez palmar fue evaluado en 167 niños, usuarios de un hospital de baja complejidad, en una zona económicamente deprimida de la ciudad de Bucaramanga. Dos pediatras determinaron la presencia del signo, según los criterios de la estrategia Atención Integrada a las Enfermedades Prevalentes de la Infancia, propuestos por la OMS y la OPS. El laboratorio de la institución determine la concentración de hemoglobina de cada uno de ellos.A partir de estos datos se obtuvieron los valores de sensibilidad,especificidad, valor predictivo positivo y valor predictivo negativo. También se estableció la concordancia entre los observadores.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">La prevalencia de anemia, en la muestra evaluada, fue el 28,74 %, la sensibilidad fue del 33,33 %, la especificidad del 79,83 %, el valor predictivo positivo del 40 % y el valor predictivo negativo del 74,80 %. La reproducibilidad de la prueba fue baja. El rendimiento de la prueba mejoró de manera sustancial cuando el punto de corte, en concentración de hemoglobina, se disminuyó de 11 g/dl, que es el propuesto por OMS, a 10,5 g/dl.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La anemia es frecuente en niños menores de 5 años de la ciudad de Bucaramanga (Colombia). El signo de palidez palmar es un recurso valioso para el diagnóstico de anemia grave pero, en los grados leve y moderado, carece de la concordancia y tiene poco rendimiento. Si se aceptan valores de corte inferiores, en las cifras de hemoglobina para la determinación de anemia, mejora la utilidad clínica del signo.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p class="elsevierStyleSimplePara elsevierViewall">The prevalence of anemia in children from Santander (Colombia), is nearly 28 %. Economic conditions make it difficult to perform the hemoglobin test in all children with suspected anemia. The palmar pallor sign has been recommended by the World Health Organization (WHO) and the Pan-American Health Organization for the diagnosis of anemia in children aged less than 5 years old; however, the yield of the test has not been established in Colombian communities. The aims of the present study were to establish the efficiency of the test and to determine its reproducibility.</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">The palmar pallor sign was evaluated in a sample of 167 children attending a low complexity hospital located in a deprived area of Bucaramanga city. Two pediatricians determined the presence of the sign, according to criteria from the “Integrated Management of Childhood Illness” strategy of the WHO and the Pan-American Health Organization. A hospital laboratory determined the concentration of hemoglobin in each of the children. Based on these data, the sensitivity, specificity,positive predictive value and negative predictive value were determined and the agreement between observers was established.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The prevalence of anemia in the sample evaluated was 28.74 %. Sensitivity was 33.33 %, specificity was 79.83 %, the positive predictive value was 40 % and the negative predictive value was 74.8 %. The reproducibility of the test was low. The yield of the test substantially improved when the hemoglobin cut-off point was reduced from 11 g/dl, which is the value proposed by the WHO, to 10.5 g/dl.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Anemia is frequent in children aged less than 5 years old in Bucaramanga city. The Palmar pallor sign is a valuable tool for the diagnosis of severe anemia, but is much less useful in mild or moderate anemia. If the hemoglobin level proposed by the WHO were lower, the palmar pallor sign would be more useful.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:38 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of the hematopoietic system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Kohls" 1 => "R. Christansen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Textbook of pediatrics of Nelson" "paginaInicial" => "1599" "paginaFinal" => "1604" "edicion" => "17th ed." "serieFecha" => "2004" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 23 | 15 | 38 |
| 2024 October | 109 | 89 | 198 |
| 2024 September | 110 | 67 | 177 |
| 2024 August | 123 | 116 | 239 |
| 2024 July | 84 | 84 | 168 |
| 2024 June | 88 | 65 | 153 |
| 2024 May | 87 | 69 | 156 |
| 2024 April | 103 | 54 | 157 |
| 2024 March | 98 | 67 | 165 |
| 2024 February | 97 | 61 | 158 |
| 2024 January | 123 | 57 | 180 |
| 2023 December | 113 | 57 | 170 |
| 2023 November | 96 | 54 | 150 |
| 2023 October | 71 | 47 | 118 |
| 2023 September | 74 | 34 | 108 |
| 2023 August | 83 | 40 | 123 |
| 2023 July | 90 | 51 | 141 |
| 2023 June | 85 | 91 | 176 |
| 2023 May | 108 | 71 | 179 |
| 2023 April | 45 | 28 | 73 |
| 2023 March | 76 | 48 | 124 |
| 2023 February | 80 | 28 | 108 |
| 2023 January | 61 | 38 | 99 |
| 2022 December | 97 | 49 | 146 |
| 2022 November | 104 | 74 | 178 |
| 2022 October | 59 | 56 | 115 |
| 2022 September | 67 | 56 | 123 |
| 2022 August | 64 | 95 | 159 |
| 2022 July | 48 | 56 | 104 |
| 2022 June | 73 | 74 | 147 |
| 2022 May | 51 | 66 | 117 |
| 2022 April | 50 | 63 | 113 |
| 2022 March | 60 | 87 | 147 |
| 2022 February | 76 | 55 | 131 |
| 2022 January | 87 | 65 | 152 |
| 2021 December | 56 | 68 | 124 |
| 2021 November | 55 | 85 | 140 |
| 2021 October | 80 | 83 | 163 |
| 2021 September | 84 | 83 | 167 |
| 2021 August | 81 | 48 | 129 |
| 2021 July | 65 | 61 | 126 |
| 2021 June | 58 | 50 | 108 |
| 2021 May | 59 | 48 | 107 |
| 2021 April | 132 | 115 | 247 |
| 2021 March | 90 | 50 | 140 |
| 2021 February | 58 | 33 | 91 |
| 2021 January | 83 | 62 | 145 |
| 2020 December | 57 | 50 | 107 |
| 2020 November | 36 | 28 | 64 |
| 2020 October | 26 | 62 | 88 |
| 2020 September | 23 | 34 | 57 |
| 2020 August | 31 | 50 | 81 |
| 2020 July | 29 | 48 | 77 |
| 2020 June | 28 | 50 | 78 |
| 2020 May | 24 | 53 | 77 |
| 2020 April | 35 | 35 | 70 |
| 2020 March | 28 | 24 | 52 |
| 2020 February | 31 | 36 | 67 |
| 2020 January | 35 | 45 | 80 |
| 2019 December | 49 | 85 | 134 |
| 2019 November | 29 | 91 | 120 |
| 2019 October | 31 | 181 | 212 |
| 2019 September | 19 | 55 | 74 |
| 2019 August | 31 | 44 | 75 |
| 2019 July | 30 | 57 | 87 |
| 2019 June | 38 | 77 | 115 |
| 2019 May | 74 | 114 | 188 |
| 2019 April | 79 | 164 | 243 |
| 2019 March | 18 | 57 | 75 |
| 2019 February | 26 | 64 | 90 |
| 2019 January | 29 | 50 | 79 |
| 2018 December | 22 | 34 | 56 |
| 2018 November | 56 | 34 | 90 |
| 2018 October | 69 | 58 | 127 |
| 2018 September | 39 | 22 | 61 |
| 2018 August | 2 | 0 | 2 |
| 2018 July | 5 | 0 | 5 |
| 2018 June | 3 | 0 | 3 |
| 2018 May | 2 | 0 | 2 |
| 2018 April | 20 | 0 | 20 |
| 2018 March | 4 | 0 | 4 |
| 2018 February | 8 | 0 | 8 |
| 2018 January | 8 | 0 | 8 |
| 2017 December | 5 | 0 | 5 |
| 2017 November | 13 | 0 | 13 |
| 2017 October | 9 | 0 | 9 |
| 2017 September | 9 | 0 | 9 |
| 2017 August | 6 | 0 | 6 |
| 2017 July | 8 | 0 | 8 |
| 2017 June | 12 | 73 | 85 |
| 2017 May | 22 | 56 | 78 |
| 2017 April | 11 | 46 | 57 |
| 2017 March | 11 | 37 | 48 |
| 2017 February | 7 | 59 | 66 |
| 2017 January | 25 | 36 | 61 |
| 2016 December | 15 | 34 | 49 |
| 2016 November | 23 | 61 | 84 |
| 2016 October | 32 | 77 | 109 |
| 2016 September | 21 | 73 | 94 |
| 2016 August | 71 | 57 | 128 |
| 2016 July | 51 | 73 | 124 |
| 2016 April | 0 | 32 | 32 |
| 2016 March | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 November | 1 | 0 | 1 |
| 2015 October | 2 | 42 | 44 |
| 2015 September | 4 | 0 | 4 |
| 2015 August | 4 | 40 | 44 |
| 2015 July | 13 | 49 | 62 |
| 2015 June | 15 | 22 | 37 |
| 2015 May | 17 | 39 | 56 |
| 2015 April | 27 | 52 | 79 |
| 2015 March | 21 | 36 | 57 |
| 2015 February | 12 | 61 | 73 |
| 2015 January | 27 | 2 | 29 |
| 2014 December | 39 | 4 | 43 |
| 2014 November | 22 | 8 | 30 |
| 2014 October | 39 | 8 | 47 |
| 2014 September | 35 | 10 | 45 |
| 2014 August | 42 | 4 | 46 |
| 2014 July | 60 | 3 | 63 |
| 2014 June | 86 | 5 | 91 |
| 2014 May | 117 | 2 | 119 |
| 2014 April | 93 | 6 | 99 |
| 2014 March | 92 | 8 | 100 |
| 2014 February | 80 | 30 | 110 |
| 2014 January | 97 | 18 | 115 |
| 2013 December | 93 | 14 | 107 |
| 2013 November | 102 | 7 | 109 |
| 2013 October | 95 | 20 | 115 |
| 2013 September | 76 | 37 | 113 |
| 2013 August | 99 | 28 | 127 |
| 2013 July | 65 | 5 | 70 |
| 2013 June | 5 | 6 | 11 |
| 2013 May | 6 | 2 | 8 |
| 2013 April | 8 | 2 | 10 |
| 2013 March | 7 | 2 | 9 |
| 2013 February | 22 | 1 | 23 |
| 2013 January | 27 | 2 | 29 |
| 2012 December | 22 | 0 | 22 |
| 2012 November | 20 | 1 | 21 |
| 2012 October | 15 | 0 | 15 |
| 2012 September | 0 | 1 | 1 |
| 2005 December | 3354 | 0 | 3354 |
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