Concordance of diagnosis between the ambulance services and emergency departments

摘要

Introduction: Diagnosis of patients in a pre-hospital setting is a challenging process that depends primarily on clinical evaluation. The pre-hospital environment presents particular challenges such as scanty information and limited diagnostic tools. Nonetheless, accurate diagnosis is key to activate the appropriate cascade of management, level(s) of dispatch and disposition. This study aims to compare the ambulance paramedic diagnosis with that determined in the Emergency Department (ED). Method: This is a multi-centered cohort prospective study comparing pre-hospital diagnosis with emergency physicians' primary diagnosis. We included all adult patients in the ED of Hamad General Hospital, Al Khor Hospital and Al Wakrah Hospital, but excluded all poly-trauma patients (trauma level 1). Pre-hospital diagnosis was reviewed from the ambulance patient care record and compared with documented primary diagnosis provided by ED physicians during August 2015. Results: A total of 747 records were reviewed; of which, 154 records were excluded from the Study due to missing data. The comparison results showed that 389 files were congruent and 200 were non-congruent. They included common diagnoses such as trauma (9%), abdominal pain (12%) and renal colic (12%), and had concordance as high as 90.5%. Conclusion: Pre-hospital diagnosis was congruent in 66% of the cases reviewed when compared with emergency physicians' provisional diagnosis. As the study did not include the final diagnosis, accuracy of diagnosis was not assessed for both the pre-hospital setting and ED physicians. The most common cause of incongruity was documenting a specific diagnosis instead of provisional diagnosis, which increases the risk of missing related differential diagnosis. Recommendations: Such studies may help identify opportunities of improvement for healthcare providers to make optimal decisions. Therefore, further studies are required to reveal the areas of improvement.