[Diagnostic consistency between primary care and specialized care following emergency consultation]

To evaluate the diagnostic concordance between primary health-care level and hospital health-care level after emergency visits.

Cross-sectional study.

Health-care area 7 in Madrid.

Any patient studied in the primary health-care level and further sent by referral request to the emergencies of the health-care area reference hospital.

The sample size was estimated according to a confidence level of 95%, a precision level of 5%, a concordance level of 50% and a 30% of referral requests without diagnosis. All diagnosis were codified by the ICD-9 CM. Single kappa index for each diagnosis and global kappa index were calculated. 559 patients were studied. 447 (80%) of the patients were referred with diagnosis and 112 (20%) without it. Kappa index was very high (> or = 0.8) for the following diagnosis: angina pectoris, and urticaria. Kappa index was high (0.6 > or = k < 0.8) for stroke, and deep venous thrombosis. It was moderate (0.4 > or = k < 0.6) for pneumonia, heart failure and heart attack. Kappa index was low (0.2 > or = k < 0.4) for appendicitis, and arthritis, and it was very low (< 0.2) for meningitis, and cellulitis. Global kappa index was 0.65 (95% CI, 0.58-0.72).

Global concordance was high. The highest concordance was obtained for diseases with clinical diagnosis. Most of diseases with low and very low concordance are diseases that need specialized clinical tests.