Comparison of Total Work Inability between Medical Examiners and Emergency Physicians

International audienceAim: We aimed to compare the total work incapacity (TTI) durations assigned by the emergency physician at admission, and assigned in hindsight by medical examiners and emergency physicians.Procedure: We included traffic and domestic accidents from the regional observatory for accidents and trauma (ORAT) that led to the allocation of a TTI. Three medical examiners and three emergency physicians allocated TTI durations in number of days, based on information from the ORAT. We reported the intra- and inter-physician quality based on 94 and 376 patients. The concordance was evaluated with the intra-class correlation coefficient (ICC). An agreement was observed between prescribers if the difference between their TTIs was less than or equal to 20% of the average of the assigned TTIs.Results: Concordance between medical examiners was moderate (CCI: 0.67 [0.51; 0.80]), also between emergency physicians (CCI: 0.62 [0.50; 0.72]) and between medical examiners and emergency physicians (CCI: 0.66 [0.59; 0.71]). We observed only 16% situations of agreements. Among the agreements, patients did not share common characteristics. They were usually admitted on the day of the accident and most often had head, face or neck injuries. Among the disagreement situations, patients had more frequent spinal cord injuries and were associated with a disability that did not affect normal function (IIS score 1).Conclusion: We observed a strong heterogeneity in the assessment between medical examiners and emergency physicians, leading to inequity in the judicial treatment of injuries and in the medical follow-up of victims