Analysis of referral diagnoses to the rheumatology department

Abstract

The initial presentation of patients with symptoms indicative of a rheumatic disease is in most cases not directly to arheumatologist. This study evaluated the following questions: I.Which medical specialists refer patients to adepartment of rheumatology? II.Evaluation of the accordance of the presumptive referral diagnosis and the final diagnosis by arheumatologist. A total of 947 patients (279 men and 668 women) who initially presented to auniversity hospital for rheumatological diagnostics were included in the study. The referring medical specialist fields were identified. Furthermore, a kappa analysis was performed to evaluate the accordance of the presumptive referral diagnosis and the final diagnosis generated after a rheumatological evaluation of the patients. Of the referrals 73% were initiated by general practitioners or internists functioning as general practitioners. The other referrers were 5% specialists in internal medicine (excluding rheumatology), 4% orthopedic/trauma surgeons, 1% other surgeons and 4% other specialist fields. A rheumatological diagnosis was made in 58% of the patients and rheumatological inflammatory joint diseases (26%), collagenosis (14%) and vasculitides (5%) were the most frequently diagnoses. The accordance of the presumptive diagnosis of the general practitioners and the final diagnosis after rheumatological evaluation was a kappa coefficient of κ = 0.304. Lower kappa values were evaluated for orthopedic surgeons (κ = 0.277) and other specialists (κ = 0.200). The referrals to a rheumatology institution were frequently initiated by general practitioners and internists functioning as general practitioners. In this context the presumptive diagnosis of general practitioners showed alow accordance with the final rheumatological diagnosis. In contrast, adetailed presumptive diagnosis is desirable for optimal use of the limited resources for rheumatological care.