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Vol. 34. Issue 1.
Pages 9-13 (January 1998)
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Vol. 34. Issue 1.
Pages 9-13 (January 1998)
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Estudio de la concordancia diagnóstica para las patologías asma y EPOC en pacientes ambulatorios
Diagnostic agreement for asthma and COPD in outpatients
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F. Baranda García*, V. Sobradillo Peña, N. Talayero Sebastián, M. Pérez de las Casas, C. Badiola Villa, E. Ciruelos Ayuso
Servicio de Neumología. Hospital de Cruces. Baracaldo. Vizcaya
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El objetivo del presente estudio ha sido evaluar la concordancia diagnóstica existente para las patologías asma y enfermedad pulmonar obstructiva crónica (EPOC), entre el diagnóstico clínico del neumólogo en el ambulatorio y el derivado de la aplicación de un protocolo diagnóstico que ha servido de referencia.

Se han incluido un total de 155 pacientes con diagnóstico ambulatorio de asma (80 pacientes) y EPOC (75 casos), con una edad media de 53 años (rango 18-84 años) de los que el 62% son varones.

Cada paciente ha sido estudiado con cuestionario CECA, espirometría basal y posbroncodilatación, registro del flujo máximo, test de provocación con histamina y estudio alérgico. Para evaluar la concordancia diagnóstica se ha empleado el método estadístico kappa.

La concordancia entre diagnósticos ambulatorios y el protocolo de referencia fue del 82%, con un valor de kappa de 0,63 (buena concordancia). El 18% del grupo quedaba sin un diagnóstico concluyente. De los 75 pacientes con diagnóstico ambulatorio de EPOC, el 78% no modificó su diagnóstico, el 12% cambió su diagnóstico a la categoría de asma, y un 9% de los pacientes quedó sin un diagnóstico definido. De los 80 enfermos con diagnóstico ambulatorio de asma, el 38% no modificó su diagnóstico, el 17,5% cambió su diagnóstico a EPOC, y el 27,5% quedó sin un diagnóstico concluyente. Las mayores dificultades se encontraban en los pacientes con asma que presentaban limitación crónica al flujo aéreo (LCFA).

Existe una buena concordancia entre los diagnósticos ambulatorios y el protocolo de referencia. La mayor modificación de diagnósticos está en los asmas que presentan LCFA. Un 18% de los pacientes permanece sin un diagnóstico concluyente.

Palabras clave:
Concordancia diagnóstica
Asma bronquial
EPOC

To evaluate agreement in diagnoses of asthma or chronic obstructive pulmonary disease (COPD) made by an outpatient clinic pneumologist and those indicated by applying a reference diagnostic protocol.

One hundred fifty-five patients diagnosed of asthma (n=80) or COPD (n=75), 62% of whom were men. Mean age was 53 years (range 18 to 84 years).

Data available for each patient included answers to the European Community for Coal and Steel questionnaire, spirometry before and after bronchodilation, peak flow measurements, and the results of histamine challenge and allergy testing. A kappa value was used to evaluate diagnostic agreement.

Agreement between diagnoses made by the outpatient pneumologist and that obtained using the protocol was 82%, with a kappa value of 0.63, indicating good agreement. No conclusive diagnoses could be made for 18% of the patients. For 78% of the 75 patients diagnosed of COPD in the outpatient clinic the diagnoses were not changed. The diagnoses of 12% were changed to asthma, and 9% were given no firm diagnoses. Of the 80 patients diagnosed of asthma in the outpatient clinic, the diagnoses of 38% were unchanged, those of 17,5% were changed to COPD, and 27,5% of the cohort was given no firm diagnosis. The greatest difflculties were encountered for patients with both asthma and chronic air flow limitation.

Agreement between outpatient clinic and reference protocol diagnoses is good. Diagnoses were most often changed for patients with both asthma and chronic air flow limitation. The proportion of patients for whom no diagnosis can be made is 18%.

Key words:
Diagnostic agreement
Bronchial asthma
Chronic obstructive pulmonary disease (COPD)
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Copyright © 1998. Sociedad Española de Neumología y Cirugía Torácica
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