Emergency department patient and physician survey accuracy compared to chart abstraction in patients with acute respiratory illness.
Emergency department patient and physician survey accuracy compared to chart abstraction in patients with acute respiratory illness.
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急诊科患者和医生对急性呼吸道疾病患者的调查准确性与图表抽象的比较。
DOI：
10.1111/acem.14810
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Caterino,Jeffrey
中科院分区：
文献类型：
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作者：
Hunold,KatherineM;Schwaderer,AndrewL;Exline,Matthew;Hebert,Courtney;Lampert,BrentC;Southerland,LaurenT;Stephens,JulieA;Boyer,EdwardW;Gure,TanyaR;Mion,LorraineC;Hill,Michael;Chu,Ching-MinB;Ernie,Edriane;Caterino,Jeffrey
背景需要在老年人中进行高质量的研究。不幸的是，以前的研究对老年患者病历审查数据的准确性提出了质疑。在疑似肺炎患者中，对这一主题知之甚少，这种疾病每年有50万名美国老年人急诊科（艾德）就诊，对艾德医生提出了诊断挑战。本研究的目的是比较直接访谈和图表抽象的数据sources.MethodsWe提出了一个预先计划的二次分析的前瞻性，观察队列的艾德患者≥65岁，怀疑肺炎在两个中西部ED。我们描述了图表审查和前瞻性直接患者调查（症状）或直接医生调查（检查结果）的标准之间的协议。数据收集图表审查和从病人和治疗医生surveillance.ResultsThe较大的研究招募了135名老年人，134个完整的症状数据和129个完整的检查数据被列入本分析。患者/法定代理人调查与病历审查之间的肺炎症状（意识模糊、不适、呼吸急促、任何咳嗽、新发/加重咳嗽、任何痰液生成、痰液变化）一致率范围为47.8%（不适）至80.6%（意识模糊）。所有检查结果（啰音、干啰音、喘鸣）在医生调查和病历审查之间的一致率≥ 80%。然而，所有kappas除了喘息小于0.60，表明弱agreement.ConclusionsBoth患者的症状和检查结果表现出图表审查和直接调查之间的差异，更大的差异，症状报告。研究人员在研究设计和数据解释过程中应考虑这些潜在的差异。
BackgroundHigh‐quality research studies in older adults are needed. Unfortunately, the accuracy of chart review data in older adult patients has been called into question by previous studies. Little is known on this topic in patients with suspected pneumonia, a disease with 500,000 annual older adult U.S. emergency department (ED) visits that presents a diagnostic challenge to ED physicians. The study objective was to compare direct interview and chart abstraction as data sources.MethodsWe present a preplanned secondary analysis of a prospective, observational cohort of ED patients ≥65 years of age with suspected pneumonia in two Midwest EDs. We describe the agreement between chart review and a criterion standard of prospective direct patient survey (symptoms) or direct physician survey (examination findings). Data were collected by chart review and from the patient and treating physician by survey.ResultsThe larger study enrolled 135 older adults; 134 with complete symptom data and 129 with complete examination data were included in this analysis. Pneumonia symptoms (confusion, malaise, rapid breathing, any cough, new/worse cough, any sputum production, change to sputum) had agreement between patient/legally authorized representative survey and chart review ranging from 47.8% (malaise) to 80.6% (confusion). All examination findings (rales, rhonchi, wheeze) had percent agreement between physician survey and chart review of ≥80%. However, all kappas except wheezing were less than 0.60, indicating weak agreement.ConclusionsBoth patient symptoms and examination findings demonstrated discrepancies between chart review and direct survey with larger discrepancies in symptoms reported. Researchers should consider these potential discrepancies during study design and data interpretation.