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"titulo" => "Diagnostic agreement between emergency teams and hospital services"
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"resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Desde hace 10 años, la Empresa Pública de Emergencias Sanitarias de Andalucía estudia la concordancia de sus equipos con la atención primaria y los hospitales. Se investiga el acuerdo diagnóstico entre estos equipos y los hospitalarios, y en caso de encontrar diferencias, se valora si éstas podrían estar en función del equipo de emergencias, el recurso de traslado o el centro hospitalario.</p> <span class="elsevierStyleSectionTitle">Pacientes y método</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo. Se incluyó a 510 pacientes (seleccionados al azar) cuyos datos se conocía, atendidos por equipos 061 de Málaga en 2001 y que precisaron traslado a algún hospital público. Se recabaron datos sobre la filiación, la asistencia recibida, el traslado, el centro hospitalario y el diagnóstico. El máximo de diagnósticos permitidos fue 3, codificados según la clasificación CIE-9 MC. Para la comparación se utilizó el índice kappa.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se perdieron 10 casos. La media de diagnósticos del 061 por paciente fue de 1,48, mientras que en los informes hospitalarios fue de 1,59. Los más frecuentes hacían referencia a traumatismos y enfermedades cardiovasculares (los inespecíficos se aproximaron al 20%). El 59% de los pacientes tenía al menos un diagnóstico coincidente. Para un nivel de confianza del 95% obtuvimos un índice kappa de 0,478 (proporción de conformidad del 73,9%).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Obtuvimos una concordancia global moderada, con mejores resultados para el Equipo de Coordinación Avanzada y traslados en ambulancia convencional por la simplicidad de los diagnósticos. Sólo llegó a niveles considerados como «buenos» el Hospital Costa del Sol, con el que se comparten las guías de trabajo. El porcentaje de diagnósticos poco precisos fue alto. Las propuestas de mejora deberán ir desde la revisión de los modos de trabajo hasta la aplicación de nuevas tecnologías.</p>"
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"en" => array:2 [
"titulo" => "Abstract"
"resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Over the last 10 years the Public Health Emergency Service of Andalusia (Spain) has been conducting a study into the diagnostic agreement among its teams (061 teams) and those of primary care and hospitals. Diagnostic agreement between these teams and hospital teams was evaluated. When discrepancies were found, an assessment was made of whether these corresponded to the emergency team, transfer resources or hospital.</p> <span class="elsevierStyleSectionTitle">Patients and method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A descriptive study was performed. Five hundred ten patients whose particulars were already known were randomly selected. The patients, who required transfer to a public hospital, received assistance from 061 teams in Malaga in 2001. Data were gathered on personal details, the assistance received, transfer, hospital and diagnosis or diagnoses. The maximum number of diagnoses permitted was three, coded in accordance with the CIE-9 CM classification. The Kappa index was used for comparisons.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Ten cases were lost due to missing data. The mean number of diagnoses per patient was 1.48 for 061 teams and was 1.50 in hospital reports. The most common of diagnoses related to injuries and cardiovascular diseases (non-specific diagnoses accounted for approximately 20%). Fifty-nine percent of the patients had at least one diagnosis that coincided. We obtained ê = 0.478 for a confidence level of 95% (the agreement rate was 73.9%).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Overall agreement was moderate, with better results in the Advanced Coordination Team and conventional ambulance transfer due to the simplicity of the diagnoses. Results classified as «good» were achieved only in the Hospital Costa del Sol, which uses working guidelines similar to those of the Public Health Emergency Service. The percentage of inexact diagnoses was high. Proposals for improvement should range from revising the working methods used to applying new technologies.</p>"
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