title: [Do age and service influence on diagnostic quality of ischemic stroke?].
abstract: BACKGROUND
  The ischemic stroke represents a very important cause of death in the hospitals. The clinic changes of this disease and the frequent morphological evidence in necropses motived the study of the clinicopathological concordance taking as reference two institutions of the secondary attention. The two medical centers were our study was conducted were: Dr. Gustavo Alderegu a Lima Hospital in Cienfuegos and Camilo Cienfuegos in Sancti Spiritus. These two Cuban hospital have showed necropses indicators higher than 80%.
  
  
  OBJECTIVE
  To determine the clinicopathological correlation of the ischemic stroke as evidence of the quality of the diagnoses. The influence of the age of the patient and kind of care received by the patient.
  
  
  METHODS
  A retrospective, descriptive, and correlational study where 1556 death with necropsy were evaluated. As main variables were studied the age and services where demise took place, as well as, the following indicators: observed concordance, kappa index, sensitivity, specificity, positive and negative predictive values, positive and negative similarity reasons.
  
  
  RESULTS
  At ischemic cerebrovascular lesions the concordance was significant with kappa values which were not higher than 0.66 in both facilities; nevertheless, sensitivity and positive predictive value were higher in Sancti Spiritus (75.5% and 63.5%, respectively). Overall, being aged was not a motive for diagnostic discordance on cerebrovascular damages, significantly the Sancti Spiritus values in the ages group were substantial: kappa (0.70), sensitivity (80.4%), and positive predictive value (19.0). Among death from 15 thought 60 years old from Sancti Spiritus province the results of measurements of diagnostic quality were reduced comparative with Cienfuegos and overall for this age group: kappa (0.37), sensitivity (42.8%), positive predictive value (37.5%). Analysis of each services evidence reductions of sensibility up to (59.1%) at clinic services of Cienfuegos with respect to (73.6%) progressive care for ischemic cerebrovascular lesions, besides a positive predictive value of (49.4%) in progressive care, lower than the results obtained for Sancti Spiritus.
  
  
  CONCLUSIONS
  The clinicopathological concordance and the rest of the quality indicators were higher in Camilo Cienfuegos Hospital in Sancti Spiritus. The age below 60 years old favoreced the diagnostic discordance in the above mentioned center. Nevertheless, patients with age over 60 years old didn t show important changes in the concordance. The quality indicators were higher in unit f intensive care respect to the clinical services. The quality in the results in the Sancti Spiritus Hospital are determined by the existence of a stroke unit
authors.affiliation: Servicio de Medicina Interna, Hospital Clínico Quirúrgico Universitario Dr, Gustavo Aldereguía Lima, Cienfuegos, Cuba. amigiraldoni@jagua.cfg.sld.cu
authors.forename: A F
authors.initials: AF
authors.lastname: Morejón-Giraldoni
authors.forename: A
authors.initials: A
authors.lastname: Reyes-Corcho
authors.forename: E
authors.initials: E
authors.lastname: Díez y Martínez de la Cotera
authors.forename: R
authors.initials: R
authors.lastname: Gómez-Baute
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002545:Brain Ischemia / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis*