Discussion
A
statistic parameter which is most commonly used in determining the
degree of agreement between admission and discharge diagnostic groups
was the Kappa coefficient.10 The results of this study
showed that the agreement of ADX and DDX
for the CVDs subgroups was satisfying (κ =0.76) but there was
significant discrepancy in some subgroups, even though some disagreement
was expected. Similarly, Result of conducted study in Brazil on 20,422
patients showed that the value kappa coefficient for CVDs was κ =0.61
(0.58 to 0.64). The value kappa coefficient for IHD (0.57) and HD (0.33)
was lower than the results of this study.5 In Canada,
the result of 13,803 hospitalization report analyzing showed that the
diagnostic group agreement was registered in 9,328 (67.6%) reports. The
value of the Kappa coefficient for 50 most common diagnostic groups was
κ = 0.81 (0.70 to 0.87). The value of the kappa coefficient for CAD
(0.86) was higher than the result of this study.12 175
(55%) of 317 patients who admitted to the general internal medicine
unit of Rush University Medical Center (RUMC) had the diagnostic
agreement, while the agreement rate of this study was
(83.5%).11 Diagnostic discrepancy in patients with
cardiac arrest was 6%, which was more than the results of this
study.13 The agreement between ADx and DDx in patients
with or with no diabetes and with below-knee amputation in the Republic
of Ireland, shows that diagnostic group agreement with diabetes patients
who had an amputation was κ = 0.82 (0.75–0.89).14
Analyzing of 1,090 patients record in Iran showed that there was (71%)
agreement between the ADX and DDX and
the agreement between DDX and autopsy result was
(72%).15 The result of some studies was similar to
this study while some of them are different.
The
result of study showed that the average of LOS was 119.9 ± 204 hours,
and the mean of patients’ age was 58.1 ± 17.1 years. The average of LOS
for the patients with angina pectoris in England was 120±72 hours and
the mean of age was 67 years.16 The result of this
study showed that there was a significant relationship between the
marriage state, LOS, sex, age and the incidence of CVDs. While a
discrepancy between the ADX and DDX was
consistently associated with the increasing of LOS, the underlying
reasons are not yet understood. This study can only speculate about the
reasons for this association, and further work is need to analysis these
hypotheses. The similarities between the symptoms of CVDs can be one of
the reason of this variation. There are several possible explanations
for discrepant cases: (1) poorer documentation at the time of admission,
(2) more complexity in terms of the diagnostic task (3) less thorough
diagnostic workup at the time of admission.
The
results of various studies show that the medical diagnosis is the first
and the most important issue in treatment approach at clinical practice.
Diagnostic agreement not only decreased the LOS and cost, it can provide
an adequate treatment immediately for a patient without unnecessary
waste of time.5 Despite improving the quality of
diagnostic technologies, the rate of diagnostic and medical errors has
not significantly decreased. Based on the findings of this study,
educational programs can be effective in reducing diagnostic errors. To
reducing these inconsistencies, the patients should be examined
carefully and avoid any inappropriate or inadequate actions at admission
time.