Frecuencia y pesquisa de síntomas en pacientes crónicos en fases avanzadas en un hospital clínico: ¿Existe concordancia entre pacientes y médicos?

Physicians tend to over or underestimate symptoms reported by patients. Therefore standardized symptom scoring systems have been proposed to overcome this drawback. Aim: To estimate the prevalence and the diagnostic accuracy of physical and psychological symptoms and delirium in patients admitted to an internal medicine service at a university hospital. Material and Methods: We studied 58 patients, 45 with metastasic cancer and 13 with other advanced chronic diseases. The following scales were used: the Confusion Assessment Method for the diagnosis of delirium; the Edmonton Symptom Assessment Scale (ESAS) for pain and other physical symptoms; the Hospital Anxiety and Depression Scale to assess anxiety and depression. The ESAS was simultaneously applied to patients without delirium and their doctors to assess the level of diagnostic concordance. Results: Twenty two percent of patients had delirium. Among the 45 patients without delirium, 11 (25%) had at least eight symptoms and 39 (88.6%) had four symptoms. The prevalence of symptoms was very high, ranging from 22 to 78%. Pain, restlesness, anorexia and sleep disorders were the most common. The concordance between symptoms reported by patients and those recorded by doctor was very low, with a Kappa index between 0.001 and 0.334. Conclusions: In our sample of chronic patients, there is a very high frequency of psychological and physical symptoms that are insufficiently recorded by the medical team