Concordancia diagnóstica entre dos métodos de detección de hemoglobina glucosilada A1c en Atención Primaria / Diagnostic agreement between two glycosylated a1b hemoglobin methods in Primary Care

Objetivo. Hay varios métodos para determinar hemoglobina glucosilada A1c (HbA1c), tanto rápidos para punto de uso en la consulta como de laboratorio. Nuestro objetivo ha sido comparar la concordancia diagnóstica entre 2 métodos de detección de HbA1c. Material y métodos. Se realizó un estudio descriptivo transversal de concordancia diagnóstica en el Centro de Salud Los Cármenes. Se incluyeron de forma consecutiva 2 grupos de pacientes con y sin diabetes mellitus tipo 2. Se compararon un método en punto de uso para consulta externa (DCATM Systems Siemens®) con otro de laboratorio (análisis cromatográfico). Se estudiaron la concentración de HbA1c y la concordancia entre los métodos con el coeficiente de correlación intraclase (CCI, A1) y con el método de Bland-Altman. Resultados. Se estudió a 102 pacientes, 62 diabéticos (60,8%) y 40 no diabéticos (39,2%). La media global ± desviación estándar de porcentaje de HbA1c fue de 6,46 ± 0,88 en el análisis con sangre capilar mediante sistema DCA(TM) y de 6,44 ± = 0,86 en el análisis del laboratorio (p > 0,05). El grado de acuerdo entre las 2 pruebas fue de 0,975 (intervalo de confianza del 95%, 0,963-0,983). La media de la diferencia entre las determinaciones de las 2 pruebas evaluadas fue de 0,024 ± 0,27. El porcentaje de puntos fuera de los límites de acuerdo óptimo definidos en el gráfico de Bland-Altman fue del 2,5%. Conclusiones. La concordancia diagnóstica entre un método para punto de uso en consulta y uno de laboratorio ha sido muy alta. La detección en punto de uso permite una rápida y sencilla valoración de la concentración de HbA1c (AU)

Objective. Several methods are available for measuring glycosylated A1c hemoglobin (HbA1c), all rapid methods for point of care use in a clinical or laboratory setting. This study attempts to compare the diagnostic agreement between two methods for detection of HbA1c. Material and methods. A descriptive cross-sectional study of diagnostic agreement was carried out in the Los Carmenes Health Centre. Two groups of patients -with and without type 2 diabetes- were consecutively included. A method for point-of-care use in a Primary Care Clinic setting (DCATM Systems Siemens®) was compared with a laboratory test (chromatographic analysis). An analysis was made of the mean concentration of HbA1c, the agreement between methods, using the intra-class correlation coefficient (CCLA1) and the Bland-Altman method. Results. A total of 102 patients were included, 62 diabetic (60.8%) and 40 non-diabetic (39.2%). The overall mean HbA1c was 6.46% (SD = 0.88) in the analysis using capillary blood in the clinic with the DCA(TM) system, and 6.44% (SD = 0.86) using the laboratory test (P>.05). The degree of agreement between the two tests was 0.975 (95% CI: 0.963-0.983). The mean of the differences between the results of the two assessed tests was 0.024 (SD = 0.27). The percentage of points outside the limits of optimal agreement, as defined in the Bland-Altman graph, was 2.5%. Conclusions. Diagnostic agreement between a method for point-of-care use in a Primary Health Care Clinic and a laboratory test was very high. Detection at the point-of-care allows a quick and simple assessment of HbA1c (AU)

[Diagnostic agreement between two glycosylated a1b hemoglobin methods in Primary Care]. / Concordancia diagnóstica entre dos métodos de detección de hemoglobina glucosilada A1c en Atención Primaria.

OBJECTIVE: Several methods are available for measuring glycosylated A1c hemoglobin (HbA1c), all rapid methods for point of care use in a clinical or laboratory setting. This study attempts to compare the diagnostic agreement between two methods for detection of HbA1c. MATERIAL AND METHODS: A descriptive cross-sectional study of diagnostic agreement was carried out in the Los Carmenes Health Centre. Two groups of patients -with and without type 2 diabetes- were consecutively included. A method for point-of-care use in a Primary Care Clinic setting (DCA(TM) Systems Siemens(®)) was compared with a laboratory test (chromatographic analysis). An analysis was made of the mean concentration of HbA1c, the agreement between methods, using the intra-class correlation coefficient (CCLA1) and the Bland-Altman method. RESULTS: A total of 102 patients were included, 62 diabetic (60.8%) and 40 non-diabetic (39.2%). The overall mean HbA1c was 6.46% (SD=0.88) in the analysis using capillary blood in the clinic with the DCA™ system, and 6.44% (SD=0.86) using the laboratory test (P>.05). The degree of agreement between the two tests was 0.975 (95% CI: 0.963-0.983). The mean of the differences between the results of the two assessed tests was 0.024 (SD=0.27). The percentage of points outside the limits of optimal agreement, as defined in the Bland-Altman graph, was 2.5%. CONCLUSIONS: Diagnostic agreement between a method for point-of-care use in a Primary Health Care Clinic and a laboratory test was very high. Detection at the point-of-care allows a quick and simple assessment of HbA1c.

[Validity of the clinical diagnosis of the basal cell carcinoma in primary health care]. / Validez del diagnóstico clínico de carcinoma basocelular en atención primaria.

OBJECTIVE: To measure the validity of the clinical diagnosis of the basal cell carcinoma (BCC) in primary care. DESIGN: Cross-sectional study. SETTING: Primary health care Area 8 in Madrid. PATIENTS AND ITNERVENTIONS: A study was carried out on a group of patients that had been histopathologically diagnosed of BCC and on another that had received any of the most frequent differential diagnoses. A sample estimate was made with the most unfavourable situation of a sensitivity and a specificity of 50%, a precision of 5%, a confidence of 95% and losses of 20%. It was estimated that 962 cases were necessary. MEASUREMENTS: The histopathological diagnosis (gold standard) were compared to the clinical diagnosis. Sensitivity, specificity, predictive values, likelihood ratios and global value were estimated. RESULTS: 963 patients were included of which 7.6% were lost 890 cases were studied, 491 with BCC and 399 with differential diagnoses. The most frequent location of BCC was the face (65.8%). Sensitivity was 27.5% (95% CI, 23.531.5%), specificity 90.5% (95% CI, 87.5-93.5%), the global value of 55.7% (95% CI, 52.7-58.7%), positive predictive value, 78.0% (95% CI, 72.084.0%) and negative predictive value 50,3% (95% CI, 46.354.3%). CONCLUSIONS: Validity was moderate with low sensitivity and very low positive predictive value, the latter estimated for its expected prevalence. The clinical diagnosis of BCC in primary health care must be complemented with other diagnostic tests.

Validez del diagnóstico clínico de carcinoma basocelular en atención primaria / Validity of the clinical diagnosis of the basal cell carcinoma in primary health care

Objetivo. Evaluar la validez del diagnóstico clínico de 'carcinoma basocelular' (CB).Diseño. Estudio descriptivo, transversal. Emplazamiento. Área 8 de Atención Primaria de Madrid. Pacientes. Se estudió a un grupo de pacientes diagnosticados histopatológicamente de CB y a otro con sus diagnósticos diferenciales más frecuentes. Se estimó una muestra con la situación más desfavorable de una sensibilidad y especificidad del 50 por ciento, una precisión del 5 por ciento, una confianza del 95 por ciento y unas pérdidas del 20 por ciento (962 sujetos).Mediciones principales. Se compararon los diagnósticos anatomopatológicos con los clínicos. Se estimaron sensibilidad, especificidad, valores predictivos, cocientes de probabilidad y valor global. Resultados. Se incluyeron 963 pacientes, con un 7,6 por ciento de pérdidas. Se estudiaron 890 casos, 491 CB y 399 diagnósticos diferenciales. La localización más frecuente del CB fue la cara (65,8 por ciento). La sensibilidad fue del 27,5 por ciento (IC del 95 por ciento, 23,5-31,5 por ciento), la especificidad del 90,5 por ciento (IC del 95 por ciento, 87,593,5 por ciento), el valor global del 55,7 por ciento (IC del 95 por ciento, 52,7-58,7 por ciento), el valor predictivo positivo del 78,0 por ciento (IC del 95 por ciento, 72,084,0 por ciento) y un valor predictivo negativo del 50,3 por ciento (IC del 95 por ciento, 46,3-54,3 por ciento). Conclusiones. Se ha obtenido una validez diagnóstica moderada con una sensibilidad baja y un valor predictivo positivo estimado para una prevalencia de CB muy baja. El diagnóstico clínico del nivel primario se debe completar con otras pruebas diagnósticas (AU)

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[Diagnostic agreement between primary and hospital care in the assessment of basal cell carcinoma]. / Concordancia diagnóstica entre atencíon primaria y atención especializada en la evaluación de carcinomas baeocelulares.

OBJECTIVE: To evaluate the diagnostic agreement between primary and hospital care. METHODS: Cross-sectional study. 491 patients who sought primary care for symptoms of suspected basal cell carcinoma and were referred to a dermatologist. The Kappa index was used to evaluate diagnostic concordance between primary and hospital care. RESULTS: The more frequent site of diagnosis was face (73.9%). The most frequent differential diagnosis in primary care was nevi (5.9%) while that in specialist care was actinic keratoses (2.2%). The diagnostic agreement was very low (kappa = 0.071; 95% IC = 0.0-0.15). CONCLUSIONS: The degree of agreement between primary and specialist care was low.

Concordancia diagnóstica entre atención primaria y atención especializada en la evaluación de carcinomas basocelulares / Diagnostic agreement between primary and hospital care on evaluating basal cell carcinoma

Objetivo: Evaluar la concordancia diagnóstica entre atención primaria y especializada. Métodos: Estudio descriptivo transversal. Se estudió a 491 pacientes que consultaron en atención primaria por clínica de carcinoma basocelular y fueron enviados al dermatólogo. Se evaluó la concordancia con el índice kappa. Resultados: La localización más frecuente fue la cara (73,9 por ciento). Los diagnósticos de confusión más frecuentes en atención primaria fueron los nevos (5,9 por ciento) y en atención especializada la queratosis actínica (2,2 por ciento). La concordancia fue muy baja ( = 0,071; IC del 95 por ciento: 0,0-0,15).Conclusiones: La concordancia entre el ámbito primario y el especializado ha sido muy baja (AU)