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2003, Number 3

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Rev Inst Nal Enf Resp Mex 2003; 16 (3)

Do age and services influence clinical diagnosis quality of lower respiratory tract sepsis?

Reyes CA, Rosa PJN, Díez MCE, Morejón GAF, Bouza JY

Language: Spanish
References: 47
Page: 136-144
PDF size: 90.80 Kb.


ABSTRACT

Context: Clinical Surgical University Hospital “Gustavo Aldereguía Lima”. Cienfuegos. Clinical Surgical University Hospital “Camilo Cienfuegos”. Sancti Spíritus (Both hospitals are situated in two provinces of the center of the Cuban island). Objective: To determine the diagnostic efficiency of lower respiratory tract infections in necropsies of deceased individuals. Patients: The necropsies of 1556 deceased individuals were studied. Of these, 915 were from the Cienfuegos Hospital and 641 necropsies from the Sancti Spíritus Hospital. There were 661clinical diagnostics and 608 pathological diagnostics of lower respiratory tract sepsis. Method: A retrospective, descriptive and correlational design was employed. We used the statistical packages: EPI INFO 6.04 CDC/OMS 2001, EPIDAT 2.0 Xunta de Galicia 1998, and the mean ratio was a= 0.05. Measurements: The variables of age and service where the patients had died, were correlated with the measurements of diagnostic efficiency: crude concordance, Kappa index (K), sensibility (S), specificity (E), positive and negative predictive values (PPV and NPV). Results and conclusions: For lower respiratory tract sepsis, concordance was moderate (k= 0.56) although it reached the substantial category in Sancti Spíritus Hospital. Both the sensitivity and the specificity surpassed 75%. The clinic pathological concordance of deceased patients less than 60 years old was high in both hospitals, although not statistically significant. The increase in diagnostic sensitivity of the elderly deceased patients due to respiratory sepsis (S=81.2%), and the decrease in specificity for the same group (71.8%) is emphasized in the Cienfuegos Hospital. Differences in NPV were found in both age groups of deceased patients from Sancti Spíritus (NPV=76.6% in the elderly and NPV=87.2% in the elderly and in the rest of deceased patients). In general, the age of 60 and more did not significantly reduce the clinical diagnostic quality of the disease. Diagnostic efficiency was reduced in the Cienfuegos IMCU fundamentally due to the differences between the Kappa index (k=0.46 vs k=0.58) and the PPV (PPV=51.7% vs PPV=80.7%). The clinic pathological discordance increased in the clinical wards of both institutions.


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