R. Gagnon1,2, K. Perreault1,2, G. Brun1, E. Matifat3,4, F. Desmeules3,4, S. Berthelot5,6, L.J. Hébert1,2,7
1Université Laval, Rehabilitation, Québec, Canada, 2Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Canada, 3Université de Montréal, School of Rehabilitation, Montréal, Canada, 4Centre de Recherche de l'Hôpital Maisonneuve-Rosemont, Montréal, Canada, 5Université Laval, Medicine, Québec, Canada, 6CHU de Québec - Université Laval, Québec, Canada, 7Université Laval, Radiology and Nuclear Medicine, Québec, Canada
Background: Overcrowding and long waiting time in the emergency department (ED) have been worrisome problems for several years in many hospitals around the world, many patients turning to the ED for the management of their musculoskeletal disorder (MSKD). As a response, hospitals in several countries have integrated, after initial nurse triage, direct access autonomous management of MSKDs by physiotherapists (PTs).
Purpose: Although the current literature on the integration of a PT in different clinical contexts such as EDs demonstrates potential benefits, few studies have examined the level of concordance between the diagnosis made by PTs and emergency physicians (EPs). A better understanding of diagnostic concordance between the PT and the EP in the ED could support decisions regarding the implementation of such a novel model of care.
Methods: This study was a secondary analysis of data obtained through a pragmatic randomized clinical trial conducted in a major academic ED in Quebec City (Canada). The intervention group had direct access to a PT in the ED and the control group was managed in the usual way by an EP. Patients aged 18 to 80 years and presenting with a minor MSKD were recruited and data from the participants randomized in the intervention group were used. Diagnostic concordance was examined using raw agreement and Gwet’s first-order agreement coefficient (AC1).
Results: Thirty-six participants were assessed by the PT and EP (36.8 ± 18.2 years old; 55.6% women). Overall raw agreement was 86.1% and an almost perfect diagnostic concordance was observed between PT and EP (Gwet’s AC1: 0.84, 95% CI: 0.69 – 0.98). The most common reason for disagreement were situations where PTs suspected a bone fracture or contusion and EPs diagnosed a ligament or meniscus disorder.
Conclusion(s): Results from this study indicate that overall diagnostic concordance between PT and EP for patients consulting with MSKDs is almost perfect. These results tend to support the safety of physiotherapy care in the ED. However, more studies are needed to confirm these results with a large variety of diagnoses and with patients of all ages.
Implications: The study of diagnostic concordance is important to support the development of models of interdisciplinary collaboration in the ED. Moreover, these results highlight the potential role of various professionals such as the PT in developing new and effective trajectories of care in the ED for MSKD patients.
Funding, acknowledgements: CHU de Québec – Université Laval, subsidies from LJH and KP, Canadian Institutes of Health Research, CIRRIS, OPPQ, Université Laval, FRQS
Keywords: musculoskeletal disorders, emergency department, diagnostic agreement
Topic: Musculoskeletal
Did this work require ethics approval? Yes
Institution: CHU de Québec - Université Laval
Committee: CHU de Québec – Université Laval Ethics Committee
Ethics number: MP-20-2019-4307
All authors, affiliations and abstracts have been published as submitted.
