Diagnostic discrepancies between emergency department admissions and hospital discharges among older adults: secondary analysis on a population-based survey

Abstract

BACKGROUND: Older adults frequently experience nonspecific clinical features. However, there is limited evidence on how often admission diagnoses for hospitalized older patients are incorrect, potentially leading to treatment delays. OBJECTIVES: To determine the consistency between hospital admission and discharge diagnoses, and identify factors associated with diagnostic discrepancies in older adults. DESIGN AND SETTING: Population-based cohort study in the United States. We included adults aged ≥ 18 years who were admitted from emergency departments (EDs) to hospitals, identified using the 2005-2010 National Hospital Ambulatory Medical Survey, a nationally representative survey. METHODS: Three admission diagnoses and the principal discharge diagnosis were captured and classified as discrepant if they involved considerably different conditions within the same organ system, or different organ systems altogether. RESULTS: Each year, 12 million adults were hospitalized following ED visits in the United States; 45% were aged ≥ 65 years. These patients' mean age was 79 years and 58% were women. Diagnostic discrepancies between admission and discharge were more common among adults ≥ 65 years (12.5 versus 8.3%; P < 0.001). Certain admission diagnoses had particularly high rates of diagnostic discrepancies: 26-27% of patients presenting with mental disorders or with endocrine and metabolic diseases had substantial diagnostic discrepancies between admission and discharge. Substantial diagnostic discrepancy was independently associated with longer hospitalization and higher in-hospital mortality. CONCLUSION: One out of eight older adults hospitalized from EDs was discharged with a principal diagnosis differing considerably from the admission diagnosis. Given that missed or delayed diagnoses are a critical safety problem, clinicians should be vigilant and frequently cogitate alternative diagnostic possibilities.

Mortality by Admission Diagnosis in Children 1–60 Months of Age Admitted to a Tertiary Care Government Hospital in Malawi

“…Furthermore, diagnoses at final disposition are not necessarily more accurate than admission diagnoses, and the concordance between the two remains unstudied in resource-limited settings. 38 – 43 …”

Incidence of Diagnostic Errors Among Unexpectedly Hospitalized Patients Using an Automated Medical History–Taking System With a Differential Diagnosis Generator: Retrospective Observational Study

“…For the primary outcome, we calculated the incidence of diagnostic errors with 95% CI. To evaluate the baseline factors and the differential diagnosis list of AI Monshin with regard to the incidence of diagnostic errors, we compared the incidence of diagnostic errors between the groups of older adults (aged ≥65 years) and non–older adults (aged <65 years) [ 37 - 40 ], the groups of males and females [ 33 ], the groups seen by staff and seen by residents [ 26 ], and the groups in which AI Monshin generated or did not generate the final diagnosis in the differential diagnosis list [ 26 ]; these comparisons were made using the Fisher exact test. We also calculated the odds ratio (OR) with 95% CI for the incidence of diagnostic errors in these groups.…”

Factors associated with misdiagnosis of hospitalised patients in general hospitals of Central Uganda

“…This approach was used by Kijima et al (2018) to investigate the diagnostic accuracy of acutely ill elderly patients seen at a primary care center and then admitted to an emergency department within four days 14 . In a study conducted in Brazil to determine diagnostic discrepancies between admission and discharge diagnosis, Avelino-Silva and Steinman (2020) stated that, while not all of the discrepancies were due to error, a large proportion of them were 18 . Similarly, a Japanese study investigated site of infection misdiagnosis by comparing discrepancies between the initial site of infection and that assigned in the final diagnosis 15 .…”

“…Previous studies that investigated diagnostic error based on the difference between admission and discharge informed the choice of this definition [14][15][16][17][18] . Hautz et al (2016) investigated diagnostic discrepancy between emergency and admission departments, hypothesizing that the discrepancy was an indicator of diagnostic error 16 .…”