In:
Academic Emergency Medicine, Wiley
Abstract:
High quality research studies in older adults are needed. Unfortunately, the accuracy of chart review data in older adult patients has been called into question by previous studies. Little is known on this topic in patients with suspected pneumonia, a disease with 500,000 annual older adult US emergency department (ED) visits that presents a diagnostic challenge to ED physicians. The study objective was to compare direct interview and chart abstraction as data sources. Methods We present a pre‐planned secondary analysis of a prospective, observational cohort of ED patients ≥65 years of age with suspected pneumonia in two Mid‐west EDs. We describe the agreement between chart review and a criterion standard of prospective direct patient survey (symptoms) or direct physician survey (exam findings). Data were collected by chart review and from the patient and treating physician by survey. Results The larger study enrolled 135 older adults; 134 with complete symptom data and 129 with complete exam data were included in this analysis. Pneumonia symptoms (confusion, malaise, rapid breathing, any cough, new/worse cough, any sputum production, change to sputum) had agreement between patient/legally authorized representative survey and chart review ranging from 47.8% (malaise) to 80.6% (confusion). All exam findings (rales, rhonchi, wheeze) had percent agreement between physician survey and chart review ≥80%. However, all kappas except wheezing were less than 0.60, indicating weak agreement. Conclusions Both patient symptoms and exam findings demonstrated discrepancies between chart review and direct survey with larger discrepancies in symptoms reported. Researchers should consider these potential discrepancies during study design and data interpretation.
Type of Medium:
Online Resource
ISSN:
1069-6563
,
1553-2712
Language:
English
Publisher:
Wiley
Publication Date:
2023
detail.hit.zdb_id:
2029751-8
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