Fiabilidad del registro del diagnóstico de la enfermedad pulmonar obstructiva crónica en Atención Primaria / Reliability of a chronic obstructive pulmonary disease diagnosis register in Primary Care

Introducción/objetivo. Una de las principales limitaciones en los estudios sobre la EPOC en bases de datos sanitarias podría ser la baja calidad de la información contenida en ellas. Nuestro principal objetivo fue evaluar la fiabilidad del diagnóstico de EPOC en Atención Primaria. En segundo término, describir las características de los pacientes en función de la conformidad del diagnóstico. Material y métodos. Estudio transversal usando bases de datos sanitarias de Cantabria. De una muestra preseleccionada se obtuvieron 1.457 pacientes etiquetados con EPOC en la historia clínica. Se verificó el diagnóstico en las mismas bases de datos y se crearon 3 grupos: EPOC-confirmada, EPOC no confirmada-no descartada y error-diagnóstico. Fueron recogidas variables descriptivas, clínicas, comorbilidades y tratamientos. Resultados. El diagnóstico de EPOC fue confirmado en 766 pacientes: 52,6% (IC 95%: 50,0-55,2). La frecuencia del error-diagnóstico fue del 7,2% (IC 95%: 5,8-8,6). El porcentaje de este sobrediagnóstico fue mayor en mujeres. La edad, el hábito tabáquico, la severidad en función del FEV1 y la frecuencia y gravedad de las agudizaciones fueron mayores en el grupo de EPOC-confirmada (p<0,001). En los errores-diagnósticos se registraron una media de 1,95 episodios en los últimos 4 años. Los corticoides inhalados estaban prescritos en el 76,9% de los pacientes con EPOC-confirmada y en el 41,9% de los errores-diagnósticos. Conclusiones. La fiabilidad del registro del diagnóstico de EPOC fue deficiente, con solo un 52,6% de certeza diagnóstica. En todos los grupos constó la prescripción de tratamientos para la EPOC de forma estable, destacando el uso de corticoides inhalados (AU)

Introduction/objective. One of main limitations in studies of COPD in health databases could be the low quality of the information. Our first aim was evaluate reliability of the registry of COPD diagnosis register in Primary Care. A description and comparison is also presented of the characteristics of the patients according to the diagnostic confirmation. Material and methods. A cross-sectional study using healthcare databases of Cantabria. A pre-selected sample of 1,457 patients was obtained in which COPD diagnosis was specifically registered. COPD confirmation was classified into confirmed COPD, not confirmed-not rejected COPD, and diagnostic error (over-diagnosis). Descriptive and clinical characteristics, comorbidities, and treatments were collected in each group. Results. COPD was confirmed in 766 patients: 52.6% (95%CI: 49.9-55.2). Prevalence of over-diagnosis was 7.2% (95%CI: 5.9-8.6). There were statistically significant gender differences. In the COPD confirmed group age, tobacco consumption and severity according to FEV1 was higher. An average of 1.95 bronchial exacerbations during the last 4years was observed among diagnostic errors. Inhaled corticosteroids were prescribed in 74.9% of COPD confirmed patients, and in 41.9% of over-diagnosed patients. Conclusions. The reliability of the COPD register was deficient, with only 52.6% with a confirmed diagnosis. Stable treatment for COPD was prescribed in all groups, highlighting the use of inhaled corticosteroids (AU)

[Reliability of a chronic obstructive pulmonary disease diagnosis register in Primary Care]. / Fiabilidad del registro del diagnóstico de la enfermedad pulmonar obstructiva crónica en Atención Primaria.

INTRODUCTION/OBJECTIVE: One of main limitations in studies of COPD in health databases could be the low quality of the information. Our first aim was evaluate reliability of the registry of COPD diagnosis register in Primary Care. A description and comparison is also presented of the characteristics of the patients according to the diagnostic confirmation. MATERIAL AND METHODS: A cross-sectional study using healthcare databases of Cantabria. A pre-selected sample of 1,457 patients was obtained in which COPD diagnosis was specifically registered. COPD confirmation was classified into confirmed COPD, not confirmed-not rejected COPD, and diagnostic error (over-diagnosis). Descriptive and clinical characteristics, comorbidities, and treatments were collected in each group. RESULTS: COPD was confirmed in 766 patients: 52.6% (95%CI: 49.9-55.2). Prevalence of over-diagnosis was 7.2% (95%CI: 5.9-8.6). There were statistically significant gender differences. In the COPD confirmed group age, tobacco consumption and severity according to FEV1 was higher. An average of 1.95 bronchial exacerbations during the last 4years was observed among diagnostic errors. Inhaled corticosteroids were prescribed in 74.9% of COPD confirmed patients, and in 41.9% of over-diagnosed patients. CONCLUSIONS: The reliability of the COPD register was deficient, with only 52.6% with a confirmed diagnosis. Stable treatment for COPD was prescribed in all groups, highlighting the use of inhaled corticosteroids.

[Thromboprophylaxis during immobilization of non-surgical traumatic injury in the lower limb. An outpatient perspective]. / Tromboprofilaxis durante inmovilización por lesión traumática no quirúrgica del miembro inferior. Un enfoque extrahospitalario.

Thromboprophylaxis with low molecular weight heparin is efficient, effective and generates savings in health costs in hospitals. However, outside hospitals, there are situations of apparent risk of thrombosis, where there seems to be no such consensus. This occurs in traumatic lower limb injuries which are not undergoing surgery and need a period of immobilization. These are processes with multidisciplinary interventions (Emergency, Family Physicians and Traumatology), although during outpatient follow up it is not easy to find criteria for using thromboprophylaxis. We report a case of a pulmonary embolism, with unusual symptoms, in an ambulatory patient with a fractured fibula and metatarsal, who was being treated with Bemiparin. As we shall see, this is a rare complication, but it shows the importance of proper risk assessment of thromboembolic disease in these patients. We emphasize the accompanying tomographic images for their clarity and eloquence.

Tromboprofilaxis durante inmovilización por lesión traumática no quirúrgica del miembro inferior. Un enfoque extrahospitalario / Thromboprophylaxis during immobilization of non-surgical traumatic injury in the lower limb. An outpatient perspective

La tromboprofilaxis mediante heparinas de bajo peso molecular es una medida eficaz, efectiva y que genera ahorro en costes sanitarios en el medio hospitalario. Sin embargo, a nivel extrahospitalario, hay situaciones de aparente riesgo trombótico, en las que parece no haber ese consenso. Esto pasa en las lesiones traumáticas del miembro inferior que no se consideran quirúrgicas y que necesitan de un periodo de inmovilización. Son episodios con intervención multidisciplinaria (urgencias, atención primaria y traumatología), aunque de seguimiento ambulatorio, donde no es fácil encontrar criterios de actuación sobre la tromboprofilaxis. Presentamos un caso clínico, con sintomatología atípica, de tromboembolia pulmonar, en un paciente con fractura de peroné y metatarso, que estaba siendo tratado con bemiparina, en su domicilio. Se trata de una complicación infrecuente, pero que muestra la importancia de una adecuada valoración del riesgo de enfermedad tromboembólica en estos pacientes. Destacan las imágenes tomográficas acompañantes, por su claridad y elocuencia (AU)

Thromboprophylaxis with low molecular weight heparin is efficient, effective and generates savings in health costs in hospitals. However, outside hospitals, there are situations of apparent risk of thrombosis, where there seems to be no such consensus. This occurs in traumatic lower limb injuries which are not undergoing surgery and need a period of immobilization. These are processes with multidisciplinary interventions (Emergency, Family Physicians and Traumatology), although during outpatient follow up it is not easy to find criteria for using thromboprophylaxis. We report a case of a pulmonary embolism, with unusual symptoms, in an ambulatory patient with a fractured fibula and metatarsal, who was being treated with Bemiparin. As we shall see, this is a rare complication, but it shows the importance of proper risk assessment of thromboembolic disease in these patients. We emphasize the accompanying tomographic images for their clarity and eloquence (AU)