Are age and care department determining variables in diagnosis quality for hemorrhagic ictus? Son la edad y el servicio variables determinantes para la calidad diagnóstica en el ictus hemorrágico?

Introduction: Hemorrhagic ictus is a significant mortality cause in hospitalized patients. The clinical variability of this disease and its frequent morphological occurrence in necropsies justify the study of clinical-pathological concordance in two institutions of secondary health care; these institutions have similar characteristics and necropsy indexes of about 80% in the last five years. Objective: To determine the clinical-pathological relation in cerebrovascular hemorrhagic disease as diagnostic quality index, patient′s age impact and the kind of provided care. Methods: Retrospective, descriptive, correlational study assessing 1556 cadavers that underwent necropsy. The age and care department in which they died were analyzed, including the following quality markers: observed concordance, kappa index, sensitivity, specificity, positive and negative predictive values, positive and negative verisimilitude ratio. Results: The most relevant result depended on concordance and diagnostic effectiveness for this stage of the disease in Sancti Spiritus (kappa = 0, 88; PPV = 86, 0 %, sensitivity = 93, 2 %, PVR =, 60.3), these numbers were higher than those of Cienfuegos province. Age proved to be a significant factor. In Sancti Spiritus ictus care unit quality markers showed the primacy of these departments. Conclusions: Age is an important variable determining the clinical diagnostic quality, mainly in elderly people. Quality markers were higher in progressive care units, when compared with clinical departments, which have an impact on the provided care. Introducción: Los ictus hemorrágicos representan una causa importante de mortalidad hospitalaria. La variabilidad clínica de esta enfermedad y su frecuente evidencia morfológica en necropsias, justifican el estudio de la concordancia clínico- patológica en dos instituciones de la atención secundaria, centros que tienen características similares e índices de necropsia cercanos al 80 % en los últimos cinco a os. Objetivo: Determinar la correlación clínico-patológica en la enfermedad cerebrovascular hemorrágica como índice de calidad del diagnóstico, y la influencia en este de la edad del paciente y el tipo de cuidados recibidos. Métodos: Estudio retrospectivo, descriptivo y correlacional, en el que se evaluaron 1556 fallecidos a los que se les realizó necropsia. Se analizaron la edad y los servicios donde ocurrió el fallecimiento, así como los siguientes indicadores de calidad: concordancia observada, índice kappa, sensibilidad, especificidad, valores predictivos positivo y negativos, razones de verosimilitud