[Diagnostic consistency between primary care and specialized care following emergency consultation]. / Concordancia diagnóstica entre atención primaria y atención especializada tras consulta urgente.

OBJECTIVE: To evaluate the diagnostic concordance between primary health-care level and hospital health-care level after emergency visits. DESIGN: Cross-sectional study. SETTING: Health-care area 7 in Madrid. PARTICIPANTS: Any patient studied in the primary health-care level and further sent by referral request to the emergencies of the health-care area reference hospital. MEASUREMENTS AND RESULTS: The sample size was estimated according to a confidence level of 95%, a precision level of 5%, a concordance level of 50% and a 30% of referral requests without diagnosis. All diagnosis were codified by the ICD-9 CM. Single kappa index for each diagnosis and global kappa index were calculated. 559 patients were studied. 447 (80%) of the patients were referred with diagnosis and 112 (20%) without it. Kappa index was very high (> or = 0.8) for the following diagnosis: angina pectoris, and urticaria. Kappa index was high (0.6 > or = k < 0.8) for stroke, and deep venous thrombosis. It was moderate (0.4 > or = k < 0.6) for pneumonia, heart failure and heart attack. Kappa index was low (0.2 > or = k < 0.4) for appendicitis, and arthritis, and it was very low (< 0.2) for meningitis, and cellulitis. Global kappa index was 0.65 (95% CI, 0.58-0.72). CONCLUSIONS: Global concordance was high. The highest concordance was obtained for diseases with clinical diagnosis. Most of diseases with low and very low concordance are diseases that need specialized clinical tests.

Concordancia diagnóstica entre atención primaria y atención especializada tras consulta urgente / Diagnostic concordance between primary and specialist care after urgent consultations

Objetivo. Evaluar la concordancia diagnóstica entre los medios intra y extrahospitalario tras consulta urgente. Diseño. Estudio descriptivo transversal. Emplazamiento. Área Sanitaria 7. Madrid. Pacientes. Cualquier paciente que hubiera consultado de forma urgente en atención primaria y hubiera sido remitido a urgencias del hospital de referencia. Mediciones y resultados principales. Se hizo una estimación muestral teniendo en cuenta una proporción de acuerdo esperado del 50 por ciento, una confianza del 95 por ciento, una precisión del 5 por ciento y una ausencia de diagnóstico en los partes de interconsulta del 30 por ciento. Se estimaron necesarios 551 casos. Se revisaron las historias clínicas del servicio de urgencias del hospital. Se codificaron los diagnósticos intra y extrahospitalarios según la clasificación internacional de enfermedades (CIE-9 MC). Se halló el índice kappa de concordancia entre diagnósticos individuales y el índice kappa global. Se revisaron los diagnósticos intra y extrahospitalarios de 559 pacientes. En 112 (20 por ciento) no se especificaba el diagnóstico extrahospitalario. El índice kappa fue muy alto (kappa >= 0,8) para la angina de pecho y urticaria. El índice kappafue alto (0,6 >= k = k = k < 0,4) para apendicitis y artritis, y muy bajo (k < 0,2) para meningitis y celulitis. El coeficiente kappa global para todos los diagnósticos fue de 0,65 (IC del 95 por ciento, 0,58-0,72). Conclusiones. La concordancia global fue alta. La concordancia más elevada se obtuvo para procesos con diagnóstico fundamentalmente clínico, y la más baja para enfermedades que requieren exploraciones complementarias especializadas (AU)

[Ischemic colitis: a descriptive analysis in a Madrid hospital]. / Colitis isquémica: análisis descriptivo en un hospital madrileño.

BACKGROUND: Ischaemic colitis represents the most common form of intestinal ischaemia and involves more commonly elderly patients with a variety of underlying conditions. This study analyses the epidemiology and clinical characteristics of the disease in our environment. PATIENTS AND METHODS: The IC cases occurred at our institution during the last two years were studied. Twenty-eight cases of IC obtained by reviewing colonoscopy and pathological records were analyzed. RESULTS: The non-occlusive type is the most common presentation form of IC. It affected elderly patients (74 +/- 10 years) with cardiovascular risk factors. Most cases manifested with abdominal pain (68%). In 64% cases, colonoscopy showed ulcerations, located mainly at descending colon and rectosigmoid. The clinical course was generally favourable with conservative measures. The overall mortality rate was 10%. CONCLUSION: The possibility of IC should be considered in the differential diagnosis of elderly patient with abdominal pain and cardiovascular risk factors.