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.