Diagnostic concordance between physiotherapist and emergency physicians for patients with a musculoskeletal disorder in the emergency department

Abstract

Question: What is the level of diagnostic concordance between physicians and physiotherapists for patients consulting in an emergency department (ED) with musculoskeletal disorders (MSKDs)? Design: Secondary analysis of data obtained through a pragmatic randomized controlled trial, physiotherapist (PT) and emergency physicians (EPs) unblinded, per-protocol analysis. Participants: 78 participants aged 18 to 80 years presenting with a minor MSKD were recruited and data from the 40 participants randomized in the intervention group were used (mean age 36.6 yrs (SD: 17.3, IQR: 22.0; 46.8); women: 55%). Outcome measures: Diagnostic concordance was established using the International Classification of Diseases 11 (ICD-11) and examined between EP and PT using raw agreement and Gwet's first-order agreement coefficient (AC1). Results: Forty participants were recruited and 36 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 was suspected bone fracture or contusion in comparison with ligament or meniscus disorder. Conclusion: Results from this study indicate that overall diagnostic concordance between PT and EP in the ED for patients consulting with MSKDs is almost perfect. These results tend to support the safety of such models of care. However, more studies are needed to confirm these results as the EP wasn't always independent and the classification used was imprecise. Registration: #NCT04009369