Concordancia diagnóstica ingreso-egreso y calidad de la indicación de complementarios en el servicio de urgencias / Diagnosis congruence on admission and on discharge and the quality of indication of laboratory testing in the emergency service

Objetivos: evaluar la correlación entre la existencia de diagnósticos concordantes al ingreso y el egreso y la calidad de la indicación de los exámenes complementarios en el servicio de urgencias. Método: estudio descriptivo transversal en 292 pacientes ingresados de urgencia en el Servicio de Medicina del Hospital Joaquín Albarrán entre enero-junio de 2011. La calidad de la indicación de los exámenes complementarios del cuerpo de guardia, se evaluaron de bien si se indicaron los exámenes necesarios o no se indicaron innecesariamente, y de mal si los exámenes indicados eran innecesarios o no se indicaron los necesarios. Se investigó la concordancia entre los diagnósticos al ingreso y egreso y se estableció su correlación con la calidad de la indicación de los exámenes complementarios. Resultados: se encontró concordancia diagnóstica entre el ingreso y el egreso en el 57,9 por ciento de los casos. La calidad de la indicación de los exámenes complementarios previos al ingreso fue mala en el 68 por ciento. En el 37,9 por ciento de los pacientes en los que la calidad de la indicación de complementarios fue buena hubo concordancia diagnóstica, y dicha indicación se consideró incorrecta en 75,6 por ciento de los casos con diagnósticos no concordantes. Conclusiones: aunque la indicación de exámenes complementarios en el cuerpo de guardia a pacientes ingresados de urgencia en medicina interna es predominantemente incorrecta y no se relaciona con una elevada correspondencia entre los diagnósticos al ingreso y egreso; dicha correspondencia es mayor en los pacientes a los que se les realiza una correcta indicación de los exámenes complementarios(AU)

Objectives: to evaluate the association between diagnosis congruence on admission and discharge and the quality of indication of laboratory testing in the emergency service. Methods: cross-sectional and descriptive study conducted in 292 hospitalized patients in the emergency medicine service of Joaquin Albarran hospital between January-June 2011 . The quality of indication of laboratory testing by the emergency service staff was rated as good if the necessary testing was indicated or it was not indicated unnecessarily, and as not good when indicated testing was unnecessary or the necessary ones were ignored. The congruence between the diagnoses on admission and those of discharge was analyzed and their correlation with the quality of indication of laboratory testing. Results: there was found diagnosis congruence on admission and on discharge in 57.9 percent of cases. The quality of indication of laboratory testing before admission to hospital was unsatisfactory in 68,0 percent of patients. In 37.9 percent of cases in which the indication of testing was rated as good, there was diagnosis congruence, but in 75.6 percent where the indication was considered incorrect, the diagnoses were incongruent. Conclusions: although the indication of laboratory testing in the emergency service to patients admitted to the internal medicine service is predominantly incorrect and is not associated with the high correspondence between diagnoses on admission to and on discharge from the hospital, such correspondence index is higher in patients who are adequately indicated the performance of laboratory testing(AU)

Identificação de transtornos de ansiedade em pacientes com suspeita de doença arterial coronariana / Identifying anxiety disorders in patients with suspected coronary artery disease

Devido ao aumento de pacientes nas emergênciasapresentando sintomas semelhantes aos de transtornode ansiedade (TA) e sintomas de doença arterial coronariana (DAC), buscou-se esclarecer a relação entre DAC e TA através de experiência vivenciada na emergência de hospital especializado e da literatura existente sobre o assunto. Foram analisados prontuários de 15 pacientes e realizada entrevista semi estruturada com cada um. Perceberam-se padrões cognitivos nesses pacientes e, como contribuição, sugeriu-se autilização de dois elementos auxiliares no diagnóstico de TA nas salas de emergência: a catastrofização e a hipervigilância.

Prompted by an upsurge of patients in emergency rooms presenting symptoms similar to those of anxiety disorder (AD) together with symptoms of coronary artery disease (CAD), an attempt was madeto clarify the relationship between CAD and AD through hands-on experience in a specialized hospital ER, in addition to the specialized literature on this subject. The medical records of fifteen patients were analyzed, followed by semi-structured interviews with each of them. Cognitive patterns were noted in these patients and, as a contribution, the use of two auxiliary elements is suggested for diagnosing AD in ERs: catastrophization and hypervigilance.