Hoffmann T, Oelzner P, Böttcher J, Wolf G, Pfeil A
Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
Institut für Diagnostische und Interventionelle Radiologie, SRH Wald-Klinikum Gera, Gera, Deutschland.
Z Rheumatol. 2020 Mar;79(2):160-167. doi: 10.1007/s00393-019-0672-1.
The initial presentation of patients with symptoms indicative of a rheumatic disease is in most cases not directly to a rheumatologist. This study evaluated the following questions: I. Which medical specialists refer patients to a department of rheumatology? II. Evaluation of the accordance of the presumptive referral diagnosis and the final diagnosis by a rheumatologist.
A total of 947 patients (279 men and 668 women) who initially presented to a university hospital for rheumatological diagnostics were included in the study. The referring medical specialist fields were identified. Furthermore, a kappa analysis was performed to evaluate the accordance of the presumptive referral diagnosis and the final diagnosis generated after a rheumatological evaluation of the patients.
Of the referrals 73% were initiated by general practitioners or internists functioning as general practitioners. The other referrers were 5% specialists in internal medicine (excluding rheumatology), 4% orthopedic/trauma surgeons, 1% other surgeons and 4% other specialist fields. A rheumatological diagnosis was made in 58% of the patients and rheumatological inflammatory joint diseases (26%), collagenosis (14%) and vasculitides (5%) were the most frequently diagnoses. The accordance of the presumptive diagnosis of the general practitioners and the final diagnosis after rheumatological evaluation was a kappa coefficient of κ = 0.304. Lower kappa values were evaluated for orthopedic surgeons (κ = 0.277) and other specialists (κ = 0.200).
The referrals to a rheumatology institution were frequently initiated by general practitioners and internists functioning as general practitioners. In this context the presumptive diagnosis of general practitioners showed a low accordance with the final rheumatological diagnosis. In contrast, a detailed presumptive diagnosis is desirable for optimal use of the limited resources for rheumatological care.
大多数情况下，出现风湿性疾病症状的患者最初并非直接就诊于风湿病专科医生。本研究评估了以下问题：一、哪些医学专科医生会将患者转诊至风湿病科？二、评估转诊时的初步诊断与风湿病专科医生最终诊断的一致性。
本研究纳入了947例最初到大学医院进行风湿病诊断的患者（279例男性和668例女性）。确定了转诊的医学专科领域。此外，进行了kappa分析，以评估转诊时的初步诊断与对患者进行风湿病评估后得出的最终诊断的一致性。
73%的转诊由全科医生或兼任全科医生的内科医生发起。其他转诊医生包括5%的内科专科医生（不包括风湿病专科）、4%的骨科/创伤外科医生、1%的其他外科医生和4%的其他专科领域医生。58%的患者被做出了风湿病诊断，其中风湿性炎性关节疾病（26%）、胶原病（14%）和血管炎（5%）是最常见的诊断。全科医生的初步诊断与风湿病评估后的最终诊断的一致性kappa系数为κ = 0.304。骨科医生（κ = 0.277）和其他专科医生（κ = 0.200）的kappa值更低。
转诊至风湿病机构的情况通常由全科医生和兼任全科医生的内科医生发起。在此背景下，全科医生的初步诊断与最终的风湿病诊断一致性较低。相比之下，为了优化利用有限的风湿病护理资源，需要做出详细的初步诊断。
