Journal Information
Vol. 10. Issue 54.
Pages 110-116 (May - June 1996)
Vol. 10. Issue 54.
Pages 110-116 (May - June 1996)
Open Access
Calidad de los diagnósticos en urgencias de las lesiones por causas externas que requieren ingreso hospitalario
Quality of emergency department injury diagnoses using hospital discharge data
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M. Segui-Gómez1, A. Plasència2,3,*, C. Borrell2
1 Injury Control Center, Harvard University, Boston MA
2 Institut Municipal de la Salut. Barcelona
3 Institut Universitari de Salut Pública de Catalunya
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Abstract
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Objetivo

Determinar la calidad de los diagnósticos realizados en losservicios de urgencias para aquellos pacientes con lesiones porcausas extemas que requieren ingreso hospitalario.

Métodos

Se recuperaron los códigos diagnósticos de las lesiones por causas externas generados en los servicios de urgencias y tras el alta hospitalaria de una muestra de 339 pacientes. Se calculó la gravedad de los pacientes con la Puntuación de la Gravedad de las Lesiones (Injury Severíty Score) utilizando un procedimiento de transformación automática délos diagnósticos. Se compararon los diagnósticos efectuados en urgencias con los del alta, clasificados en categorías diagnósticas, y se evaluó su calidad utilizando medidas de exactitud (grupos de Percy) y repetibilidad (porcentaje de concordancia). La repetibilidad de la medida de la gravedad resultante se determinó con el porcentaje de concordancia y el coeficiente de correlación intraclase.

Resultados

Se recogió una media de 1,1 diagnósticos por individuo en urgencias y 1,4 tras el alta. Al alta se notificaron más diagnósticos en cada categoría, excepto en aquellas que incluyen lesiones más inespecíficas. En general, la información de urgencias infranotificó los diagnósticos. La comparación de la distribución de la gravedad utilizando ambas fuentes de información indica valores superiores con la información al alta, aunque la correlación (0,61) indica una fiabilidad de moderada a buena. El porcentaje de concordancia de la gravedad agrupada en categorías fue del 63%.

Conclusión

En los servicios hospitalarios de urgencias se recoge información diagnóstica relativa a la gravedad de los individuos que requieren ingreso hospitalario de suficiente calidad para ser utilizada para monitorizar tendencias en la magnitud y distribución de las lesiones por causas externas a nivel poblacional. Sin embargo, para estudios específicos relativos a la gravedad de las lesiones de los individuos ingresados, se recomienda la utilización de la información diagnóstica al alta.

Palabras clave:
Accidentes
Urgencias
Alta hospitalaria
Gravedad
Validez
Repetibilidad
Exactitud
Summary
Objective

To establish the quality of emergency department diagnoses for those patients whose injuries required hospital admission.

Methods

Emergency and hospital discharge diagnostics were retrieved for 339 injured patients. Severity scores (ISS) were calculated using an automatic conversion procedure (ICDMAP). Emergency diagnoses for each patient (grouped into categories) were compared with the hospital discharge ones. Quality was analyzed based on accuracy (Percy groups) and reliability (percentage of concordance) measurements. Severity scores were evaluated using reliability measures (percentage of concordance and intraclass correlation coefficient -ICC-).

Results

Mean diagnoses per patient were 1.1 at the emergency department and 1.4 at hospital discharge. In the latter, there were diagnoses in each category except for those more unspecific, where there was a reduction. Overall,emergency information showed under notification. Severity scores were higher with hospital discharge data. There was a 63% percentage of concordance. When grouped into categories, severity scores had an ICC of 0.61 (moderate-good).

Conclusion

Emergency departments are a potential good source of information about injury severity even for those patients who require hospital admission. Emergency department injury surveillance can be very useful in assessing the magnitude and distribution of injury severity at the population level. Nevertheless for individual severity assessment, use of hospital discharge information is recommended.

Key words:
Injuries
Emergency room
Hospital discharge
Severity
Validity
Reliability
Accuracy
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Copyright © 1996. Sociedad Española de Salud Pública y Administración Sanitaria
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