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Evaluación del acuerdo entre los diagnósticos de los registros médicos y los diagnósticos de los evaluadores
K M Adams1, G S Woodard1, J Ehrenreich-May1
1University of Miami Department of Psychology, Coral Gables, FL, USA.
Evidence-based practice in child and adolescent mental health
|August 26, 2025
Resumen
El acuerdo diagnóstico entre los médicos y los investigadores es pobre para los trastornos de ansiedad juvenil. Esto pone de relieve una brecha en el diagnóstico y el tratamiento, lo que sugiere que las entrevistas semiestructuradas pueden identificar afecciones perdidas.
Área de la Ciencia:
- Psiquiatría Infantil y Adolescente
- Investigación en servicios de salud mental
- Precisión del diagnóstico
Sus antecedentes:
- Los trastornos de ansiedad juveniles son comunes, pero con frecuencia no reciben el suficiente tratamiento.
- Las discrepancias en los diagnósticos entre médicos e investigadores pueden conducir a un diagnóstico erróneo y a un tratamiento inadecuado.
- La investigación limitada aborda específicamente el acuerdo diagnóstico para los trastornos de ansiedad en los jóvenes.
Objetivo del estudio:
- Evaluar el acuerdo de diagnóstico entre los médicos comunitarios y los evaluadores independientes (IE) afiliados a la investigación.
- Evaluar la concordancia diagnóstica para varios trastornos de salud mental, con un enfoque en los trastornos de ansiedad en una población pediátrica.
Principales métodos:
- Los evaluadores independientes administraron el Programa de Entrevistas de Trastornos de Ansiedad para DSM-5, Versión Infantil a 103 jóvenes en un ensayo controlado aleatorizado.
- El acuerdo diagnóstico se cuantificó utilizando kappas de Cohen.
- Los participantes eran adolescentes (edad media de 14,3 años), con una mayoría que se identificaba como mujer, heterosexual, hispana / latina y blanca.
Principales resultados:
- Los evaluadores independientes asignaron significativamente más diagnósticos que los médicos de la comunidad.
- No se encontró acuerdo diagnóstico para los grupos de ansiedad, trauma/ estrés o trastorno obsesivo-compulsivo (kappa < 0,20).
- Se observó un acuerdo mínimo para la depresión (kappa = 0,28), los trastornos del comportamiento (kappa = 0,49) y el trastorno de pánico (kappa = 0,32).
Conclusiones:
- El acuerdo diagnóstico entre los médicos de la comunidad y los investigadores es notablemente pobre, especialmente para los trastornos de ansiedad en los jóvenes.
- Las entrevistas semiestructuradas pueden identificar diagnósticos pasados por alto en entornos clínicos comunitarios.
- Se necesitan más investigaciones para abordar los obstáculos a la aplicación de herramientas de evaluación basadas en la evidencia en los servicios comunitarios de salud mental.
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