De Lorenzo-Pinto Ana, García-Sánchez Raquel, Durán-García Esther, Castuera-Gil Ana, Pascual-Izquierdo Cristina, Marzal-Alfaro Belén, Arrabal-Durán Paula, Herranz-Alonso Ana, Andueza-Lillo Juan A, Sanjurjo-Sáez María
Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Emergency Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Eur J Hosp Pharm. 2016 May;23(3):141-144. doi: 10.1136/ejhpharm-2015-000694. Epub 2015 Nov 6.
To evaluate the level of concordance between the 2007 PRETEMED guidelines and the 2012 American College of Chest Physicians (ACCP) guidelines in medical patients at admission.
A cross-sectional, observational and descriptive study was designed and included all adult medical patients admitted from an emergency department. Firstly, patients classified as low-moderate risk and high risk according to PRETEMED were compared to those classified by ACCP as low and high risk. Secondly, the same analysis was performed but this time low and moderate-high risk patients according to PRETEMED were compared to ACCP low and high risk patients. The level of concordance was calculated using the kappa concordance index. The study was approved by the Ethics Committee for Clinical Research of the hospital.
The analysis was performed with 207 patients; 53.1% were male and the median age was 75.3 years (minimum 18, maximum 100 years old). The most common diagnosis at admission was related to a respiratory disease (37.2%). The level of concordance was 0.59 (95% CI 0.48 to 0.70) when moderate risk patients were grouped with low-risk patients and 0.53 (95% CI 0.42 to 0.65) when moderate risk patients were grouped with high-risk patients.
The level of concordance between both guides is moderate. It would be helpful to confirm whether the level of agreement improves when the patient's condition stabilises after several days of hospitalisation.
评估2007年PRETEMED指南与2012年美国胸科医师学会（ACCP）指南在成年内科住院患者入院时的一致性水平。
设计一项横断面、观察性和描述性研究，纳入所有从急诊科收治的成年内科患者。首先，将根据PRETEMED分类为低-中度风险和高风险的患者与根据ACCP分类为低风险和高风险的患者进行比较。其次，进行同样的分析，但这次将根据PRETEMED分类为低风险和中-高风险的患者与ACCP分类的低风险和高风险患者进行比较。使用kappa一致性指数计算一致性水平。该研究获得了医院临床研究伦理委员会的批准。
对207例患者进行了分析；53.1%为男性，中位年龄为75.3岁（最小18岁，最大100岁）。入院时最常见的诊断与呼吸系统疾病有关（37.2%）。当将中度风险患者与低风险患者归为一组时，一致性水平为0.59（95%CI 0.48至0.70）；当将中度风险患者与高风险患者归为一组时，一致性水平为0.53（95%CI 0.42至0.65）。
两个指南之间的一致性水平为中等。确认患者住院几天后病情稳定时一致性水平是否提高将有所帮助。
