Discrepancy between patient-reported and clinician-documented symptoms for myocardial perfusion imaging: initial findings from a prospective registry

Abstract

Abstract Background Occasionally, the symptoms reported by patients disagree with those documented in the medical record. We designed the Patient Centered Assessment of Symptoms (PCAS) registry to measure discrepancies between patient-reported and clinician-documented symptoms. Objective Use patient-derived symptoms data to measure discrepancies with clinical documentation. Methods The PCAS registry captured data from a prospective cohort of patients undergoing myocardial perfusion imaging (MPI) and includes free response and structured questions to gauge symptoms. Clinician-documented symptoms were extracted from the patients’ medical records. The appropriateness of testing was determined twice: once using the patient-reported symptoms and once using the clinician-documented symptoms. Results A total of 90 subjects were enrolled, among whom diabetes (36.7%), prior coronary disease (28.9%), hypertension (80.0%) and hyperlipidemia (85.6%) were common. Percentage of patient-reported symptoms compared to clinician-documented symptoms and agreement were as follows: chest pain (patient 29.0%, clinician 36.6%, moderate [kappa = 0.54]), chest pressure (patient 18.3%, clinician 10.8%, fair [kappa = 0.27]), dyspnea (patient 41.0%, clinician 36.6%, fair [kappa = 0.28]), onset with exertion (patient 61.7%, clinician 59.6%, slight [kappa = 0.17]), symptoms same as prior coronary artery disease (patient 46.2%, clinician 15.3%, slight [kappa = 0.01]). As a result of these inconsistencies, appropriateness ratings were different for 13.3% (n = 12) subjects. Conclusion In this prospective registry of patients undergoing MPI, we observed substantial disagreements between patient-reported and clinician-documented symptoms. Disagreement resulted in a considerable proportion of MPI appropriateness ratings also being incongruous.