Bracho-Blanchet Eduardo, Cazares-Rangel Joel, Zalles-Vidal Cristian, Davila-Perez Roberto
Faculty, Department of General Surgery, Hospital Infantil de Mexico Federico Gomez , Secretaria de Salud, Mexico, D.F.
J Clin Diagn Res. 2014 Apr;8(4):TC01-5. doi: 10.7860/JCDR/2014/7988.4241. Epub 2014 Apr 15.
The literature on diagnosis and management prior to transfer paediatric surgical patients to a tertiary care center is scarce. In referral centers, it is common to receive patients previously subjected to inadequate or inappropriate health care.
Analyze the prevalence of misdiagnosis and quality of management in patients before being referred and factors related to misdiagnosis and inadequate management.
Prospective, longitudinal, comparative study between patients with appropriate and inappropriate submission diagnosis and between patients with adequate or inadequate treatment.
Third level care hospital, Mexico City.
Newborn to adolescents referred to Paediatric Surgery Department.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Misdiagnosis and quality of management prior to being referred.
Two hundred patients were evaluated. Correlation between submission diagnosis and final diagnosis showed that 70% were correct and 30% incorrect; 48.5% were properly managed and 51.5% inappropriately managed. Incorrect diagnosis was more frequent when referred from first-or second-level hospitals and in inflammatory conditions. Patients referred by paediatricians had a higher rate of adequate management.
We present the frequency of incorrect diagnosis and inadequate patient management in a highly selected population. Sample size should be increased as well as performing these studies in other hospital settings in order to determine whether the results are reproducible.
关于将小儿外科患者转诊至三级护理中心之前的诊断和管理的文献很少。在转诊中心，接收之前接受过不充分或不适当医疗护理的患者很常见。
分析转诊前患者误诊的患病率、管理质量以及与误诊和管理不充分相关的因素。
对提交诊断恰当与不恰当的患者以及治疗充分与不充分的患者进行前瞻性、纵向、对比研究。
墨西哥城的三级护理医院。
转诊至小儿外科的新生儿至青少年患者。
无。
转诊前的误诊和管理质量。
对200例患者进行了评估。提交诊断与最终诊断之间的相关性表明，70%正确，30%错误；48.5%得到妥善管理，51.5%管理不当。从一级或二级医院转诊以及患有炎症性疾病的患者中，误诊更为常见。由儿科医生转诊的患者得到充分管理的比例更高。
我们呈现了在经过高度筛选的人群中误诊和患者管理不充分的发生率。应增加样本量，并在其他医院环境中开展这些研究，以确定结果是否具有可重复性。
