[Do age and service influence on diagnostic quality of ischemic stroke?]. / ¿Influyen la edad y servicio en la calidad diagnóstica de los ictus isquémicos?

BACKGROUND: The ischemic stroke represents a very important cause of death in the hospitals. The clinic changes of this disease and the frequent morphological evidence in necropses motived the study of the clinicopathological concordance taking as reference two institutions of the secondary attention. The two medical centers were our study was conducted were: Dr. Gustavo Alderegu a Lima Hospital in Cienfuegos and Camilo Cienfuegos in Sancti Spiritus. These two Cuban hospital have showed necropses indicators higher than 80%. OBJECTIVES: To determine the clinicopathological correlation of the ischemic stroke as evidence of the quality of the diagnoses. The influence of the age of the patient and kind of care received by the patient. PATIENTS AND METHODS: A retrospective, descriptive, and correlational study where 1556 death with necropsy were evaluated. As main variables were studied the age and services where demise took place, as well as, the following indicators: observed concordance, kappa index, sensitivity, specificity, positive and negative predictive values, positive and negative similarity reasons. RESULTS: At ischemic cerebrovascular lesions the concordance was significant with kappa values which were not higher than 0.66 in both facilities; nevertheless, sensitivity and positive predictive value were higher in Sancti Spiritus (75.5% and 63.5%, respectively). Overall, being aged was not a motive for diagnostic discordance on cerebrovascular damages, significantly the Sancti Spiritus values in the ages group were substantial: kappa (0.70), sensitivity (80.4%), and positive predictive value (19.0). Among death from 15 thought 60 years old from Sancti Spiritus province the results of measurements of diagnostic quality were reduced comparative with Cienfuegos and overall for this age group: kappa (0.37), sensitivity (42.8%), positive predictive value (37.5%). Analysis of each services evidence reductions of sensibility up to (59.1%) at clinic services of Cienfuegos with respect to (73.6%) progressive care for ischemic cerebrovascular lesions, besides a positive predictive value of (49.4%) in progressive care, lower than the results obtained for Sancti Spiritus. CONCLUSIONS: The clinicopathological concordance and the rest of the quality indicators were higher in Camilo Cienfuegos Hospital in Sancti Spiritus. The age below 60 years old favoreced the diagnostic discordance in the above mentioned center. Nevertheless, patients with age over 60 years old didn t show important changes in the concordance. The quality indicators were higher in unit f intensive care respect to the clinical services. The quality in the results in the Sancti Spiritus Hospital are determined by the existence of a stroke unit

¿Influyen la edad y el servicio en la calidad diagnóstica de los ictus isquémicos? / Do the age and service influence on diagnostic quality of ischemic stroke?

Introducción. Los ictus isquémicos representan una causa importante de morbimortalidad hospitalaria. La variabilidad clínica de esta enfermedad y su frecuente evidencia morfológica en las necropsias motivaron el estudio de la concordancia clinicopatológica en dos instituciones de la atención secundaria, los hospitales Dr. Gustavo Aldereguía Lima y Camilo Cienfuegos, en las provincias de Cienfuegos y Sancti Spiritus, en Cuba. En ambos centros se exhiben indicadores de necropsia superiores al 80 por ciento.Objetivos. Determinar la correlación clinicopatológica en la enfermedad cerebrovascular isquémica como índice de calidad del diagnóstico, y la influencia de la edad del paciente y el tipo de cuidados recibidos. Pacientes y métodos. Estudio retrospectivo, descriptivo y correlacional, en el que se evaluaron 1.556 fallecidos con necropsia. Como principales variables, se estudiaron la edad y el servicio donde ocurrió el fallecimiento, así como los siguientes indicadores: concordancia observada, índice k, sensibilidad, especificidad, valores predictivos positivo y negativo, razones de verosimilitud positiva y negativa. Resultados. En los accidentes cerebrovasculares (ACV) isquémicos, la concordancia fue sustancial, con valores de k que no superaron 0,66 en ambos centros; sin embargo, la sensibilidad y el valor predictivo positivo fueron superiores en Sancti Spiritus (75,5 y 63,5 por ciento, respectivamente). De manera global, ser anciano no motivó discordancia diagnóstica en los ACV; significativamente, los indicadores de Sancti Spiritus en este grupo de edad fueron sustanciales: k, 0,70; sensibilidad, 80,4 por ciento, y valor predictivo positivo, 19,0. En los fallecidos de 15-60 años de la provincia de Sancti Spiritus se redujeron los resultados de las mediciones de calidad diagnóstica respecto a Cienfuegos y al general para este grupo de edad: k, 0,37; sensibilidad, 42,8 por ciento, y valor predictivo positivo, 37,5 por ciento. El análisis por servicios evidencia reducciones de la sensibilidad del 59,1 por ciento en los servicios clínicos de Cienfuegos respecto al 73,6 por ciento en cuidados progresivos para los ACV isquémicos, además de un valor predictivo positivo de 49,4 por ciento en cuidados progresivos, inferior a los resultados obtenidos por Sancti Spiritus. Conclusiones. La concordancia clinicopatológica y el resto de las mediciones fueron mayores en el hospital de Sancti Spiritus; la edad menor de 60 años favoreció la discordancia diagnóstica en dicho centro. Sin embargo, los mayores de 60 años no motivaron cambios importantes en la concordancia. Los indicadores de calidad fueron superiores en las unidades de cuidados progresivos con respecto a los servicios clínicos; la calidad de los resultados en el hospital de Sancti Spiritus está determinada por la presencia de una Unidad de Cuidados Intensivos al Ictus (AU)

Background. The ischemic stroke represents a very important cause of death in the hospitals. The clinic changes of this disease and the frequent morphological evidence in necropses motived the study of the clinicopathological concordance taking as reference two institutions of the secondary attention. The two medical centers were our study was conducted were: Dr. Gustavo Aldereguía Lima Hospital in Cienfuegos and Camilo Cienfuegos in Sancti Spiritus. These two Cuban hospital have showed necropses indicators higher than 80%. Objectives. To determine the clinicopathological correlation of the ischemic stroke as evidence of the quality of the diagnoses. The influence of the age of the patient and kind of care received by the patient. Patients and methods. A retrospective, descriptive, and correlational study where 1556 death with necropsy were evaluated. As main variables were studied the age and services where demise took place, as well as, the following indicators: observed concordance, kappa index, sensitivity, specificity, positive and negative predictive values, positive and negative similarity reasons. Results. At ischemic cerebrovascular lesions the concordance was significant with kappa values which were not higher than 0.66 in both facilities; nevertheless, sensitivity and positive predictive value were higher in Sancti Spiritus (75.5% and 63.5%, respectively). Overall, being aged was not a motive for diagnostic discordance on cerebrovascular damages, significantly the Sancti Spiritus values in the ages group were substantial: kappa (0.70), sensitivity (80.4%), and positive predictive value (19.0). Among death from 15 thought 60 years old from Sancti Spiritus province the results of measurements of diagnostic quality were reduced comparative with Cienfuegos and overall for this age group: kappa (0.37), sensitivity (42.8%), positive predictive value (37.5%). Analysis of each services evidence reductions of sensibility up to (59.1%) at clinic services of Cienfuegos with respect to (73.6%) progressive care for ischemic cerebrovascular lesions, besides a positive predictive value of (49.4%) in progressive care, lower than the results obtained for Sancti Spiritus. Conclusions. The clinicopathological concordance and the rest of the quality indicators were higher in Camilo Cienfuegos Hospital in Sancti Spiritus. The age below 60 years old favoreced the diagnostic discordance in the above mentioned center. Nevertheless, patients with age over 60 years old didn’t show important changes in the concordance. The quality indicators were higher in unit f intensive care respect to the clinical services. The quality in the results in the Sancti Spiritus Hospital are determined by the existence of a stroke unit (AU)