Analysis of the accuracy of clinical diagnosis in an internal medicine department of a regional hospital: Inter-MONF study

Abstract

Introduction

There are numerous studies examining the diagnostic accuracy of various supplementary tests; however, the literature focused on diagnostic accuracy derived from clinical reasoning and data is limited. Consequently, we conducted a study to assess the diagnostic accuracy of the professionals in the Internal Medicine Department at our hospital and to examine whether there are variations in accuracy related to specific pathologies and across different time periods, particularly before and after the emergence of the SARS-CoV-2 pandemic.

Methods

This is a retrospective, longitudinal, and observational study conducted in the Internal Medicine Department of the Regional Hospital of Monforte de Lemos from 2016 to 2022, encompassing both pre- and post-SARS-CoV-2 pandemic periods. The initial diagnosis made upon patient admission was compared with the final diagnosis at discharge through an independent peer review process.

Results

The diagnostic concordance at admission and discharge was 77.4%, with statistically significant differences observed between age groups (with higher concordance in patients under 55 years of age) and according to sex, with greater concordance in female patients. No differences were found regarding pathology type or temporal cohort.

Conclusions

The diagnostic accuracy of the healthcare professionals in the Internal Medicine Department at Monforte Public Hospital during the study periods was found to be high. Diagnostic concordance was greater in female patients and those under 55 years of age, with no significant differences observed across the most prevalent pathological conditions. Furthermore, the restrictive measures implemented during the SARS-CoV-2 pandemic do not appear to have negative affected diagnostic accuracy when compared to previous periods.

Resumen

Introducción

Existen varios estudios sobre la precisión diagnóstica de las pruebas complementarias múltiples, pero la literatura sobre la precisión diagnóstica basada en el razonamiento clínico y los datos es escasa. Por ello, hemos realizado un estudio para determinar la precisión diagnóstica de los profesionales del servicio de medicina interna de nuestro hospital y valorar si existen variaciones con respecto a la enfermedad y a los diferentes marcos temporales, antes y después de la pandemia de SARS-CoV-2.

Métodos

Se trata de un estudio observacional longitudinal retrospectivo realizado en el Servicio de Medicina Interna del Hospital Comarcal de Monforte de Lemos entre 2016 y 2022, antes y después de la pandemia de SARS-CoV-2. Se compara el diagnóstico realizado al ingreso con el diagnóstico final al alta mediante revisión por pares independientes.

Resultados

La concordancia diagnóstica al ingreso y al alta fue del 77,4%, con diferencias estadísticamente significativas entre grupos de edad (mayor en el grupo de pacientes menores de 55 años) y según el sexo, con mayor concordancia entre las mujeres. No se observaron diferencias según el tipo de enfermedad o la cohorte temporal.

Conclusiones

La precisión diagnóstica de los profesionales del Servicio de Medicina Interna del Hospital Público de Monforte en los periodos estudiados es alta. La concordancia es mayor en las mujeres y en los menores de 55 años, sin diferencias significativas entre los grupos de enfermedades más prevalentes. Las medidas restrictivas adoptadas durante la pandemia de SARS-CoV-2 no parecen haber influido negativamente en la precisión diagnóstica previa.