Ladewig BGI, Pérez VSI, Romero GJ, Gómez FG, Oropeza OE, Dufoo OM

Language: Spanish
References: 11
Page: 107-113
PDF size: 115.49 Kb.

ABSTRACT

Introduction: most of the spinal disorders are initially approached by emergency physicians, as well as first contact physicians. Although most of these pathologies have benign and self-limited origins, around 5% have a severe cause which, if left untreated, can have a poor outcome secondary to neurological damage. Objective: the objective of the study is to identify and analyze the capacity of the emergency physician to determine the need for an evaluation by the specialist in diseases of the spine. Material and methods: an observational, cross-sectional and retrospective study was carried out at the Spine Clinic of the Mexico City Health Secretariat between February 2017 and February 2019. The exposure assessment was carried out through the assessments requested by the emergency service; the evaluation of the result was carried out according to the treatment plan of each of the patients. In order to obtain concordance between the interconsultation evaluations of the patient admission services and the need for evaluation by the spine clinic according to the follow-up plan (two categorical variables), the percentage of concordance and Cohen's Kappa index was used. Results: 1,665 subjects were evaluated. The median time elapsed between admission to the hospital service and the assessment by the Spine Clinic was 15.5 minutes (IQR 31.5 minutes); 61.9% of the patients were assessed in less than 30 minutes. The evaluation of the concordance between the interconsultations carried out and the need for assessment was obtained through the evaluation of the percentage of agreement, obtaining 42.70%. The Cohen's Kappa index obtained was -0.0309 (p-value 0.9999), interpreting it as a poor strenght of agreement, according to the p-value, it is concluded that there is no concordance between the interconsultations carried out and the need for assessment. Conclusions: in our study we found that the care of the patient who goes to the emergency department with spinal pathology receives prompt attention, however, the concordance of the interconsultations requested with the need for evaluation is poor. To comply with patient safety standards, it is necessary to increase this concordance, so we propose to increase it through continuous medical education with actualization courses proposed by the Spine Clinic to first contact doctors.

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