[Diagnostic consistency between primary care and specialized care following emergency consultation].

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.