RESUMO
Introducción: Determinar la concordancia entre los médicos de un Servicio de Urgencias y un radiólogo en la interpretación de la radiografía de tórax (RxT) de pacientes ingresados en una unidad de estancia corta (UEC) y evaluar si ello influye en la estancia media. Material y método: Se revisaron las historias clínicas de los pacientes ingresados en una UEC durante 4 meses. Se comparó la interpretación de la RxT realizada por el médico responsable del paciente en urgencias con la interpretación realizada por un radiólogo. Se determinó la estancia media y se analizó si la lectura de la RxT previa al ingreso por el radiólogo hubiera mejorado la estancia media. Resultados: Se revisaron 260 historias clínicas. La concordancia total fue del 74,2%, siendo mayor cuando el médico de urgencias era un residente mayor o un adjunto que cuando era un residente menor (82% vs 66,4%; p < 0,003). No se observaron diferencias según el horario en el que se realizó la lectura. Solo en 9 casos (3,5%) se hubiera producido un cambio de diagnóstico y/o tratamiento. No se produjeron cambios en la estancia media de los pacientes según existiera concordancia o no, aunque en los casos en que se hubiera producido un cambio de diagnóstico y/o tratamiento se observó una tendencia a su aumento.Conclusiones: La lectura de la RxT por un radiólogo previa al ingreso en una UEC no está justificada en todos los casos. Podría realizarse cuando el residente mayor o el adjunto de guardia tuvieran dudas en su interpretación. Una mayor supervisión de los residentes menores podría mejorar el rendimiento diagnóstico de la RxT
Introduction: To assess the agreement between physicians of the emergency department and a radiologist in the interpretation of chest roentgenograms in patients admitted to the short-stay unit, and to determine the effect of concordance on the mean length of stay. Material and method: The medical records of patients admitted to the short-stay unit over a 4-month period were reviewed. The interpretation of the chest X-ray film made by the physician in charge of the patient at the emergency department with that made by the radiologist was compared. The mean length of stay was determined and it was analyzed if the reading of the radiograph made by the radiologist before admission would decrease the length of stay. Results: A total of 260 medical records were reviewed. The overall degree of agreement was 74.2% but it was greater when the physician at the emergency department was a staff physician or a resident in the final period of training than a resident in the initial period of training (82% vs 66.4%, p < 0.003). There were no statistically significant differences regarding the day hours at which readings were made. A change in the diagnosis and/or treatment of the patient would had occurred in only 9 cases (3.5%). There were no changes in the mean length of stay according to the presence or absence of concordance, although there was a trend towards an increase in the length of stay for those cases in which diagnosis and/or treatment would had been different. Conclusions: Readings of chest roentgenograms by a radiologist before admission to a short-stay unit does not appear to be justified for all patients, although it may be justified when a staff physician or a resident in the final period of training have doubts regarding interpretation of the radiographic images. A better supervision of residents in the initial period of training may contribute to improve the diagnostic reliability of chest X-ray films
Assuntos
Idoso , Humanos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Radiografia Torácica/estatística & dados numéricos , Prontuários Médicos/estatística & dados numéricos , Variações Dependentes do ObservadorRESUMO
INTRODUCTION: To assess the agreement between physicians of the emergency department and a radiologist in the interpretation of chest roentgenograms in patients admitted to the short-stay unit, and to determine the effect of concordance on the mean length of stay. MATERIAL AND METHOD: The medical records of patients admitted to the short-stay unit over a 4-month period were reviewed. The interpretation of the chest X-ray film made by the physician in charge of the patient at the emergency department with that made by the radiologist was compared. The mean length of stay was determined and it was analyzed if the reading of the radiograph made by the radiologist before admission would decrease the length of stay. RESULTS: A total of 260 medical records were reviewed. The overall degree of agreement was 74.2% but it was greater when the physician at the emergency department was a staff physician or a resident in the final period of training than a resident in the initial period of training (82% vs 66.4%, p < 0.003). There were no statistically significant differences regarding the day hours at which readings were made. A change in the diagnosis and/or treatment of the patient would had occurred in only 9 cases (3.5%). There were no changes in the mean length of stay according to the presence or absence of concordance, although there was a trend towards an increase in the length of stay for those cases in which diagnosis and/or treatment would had been different. CONCLUSIONS: Readings of chest roentgenograms by a radiologist before admission to a short-stay unit does not appear to be justified for all patients, although it may be justified when a staff physician or a resident in the final period of training have doubts regarding interpretation of the radiographic images. A better supervision of residents in the initial period of training may contribute to improve the diagnostic reliability of chest X-ray films.
