Diagnostic error increases mortality and length of hospital stay in patients presenting through the emergency room

Abstract

Background: Diagnostic errors occur frequently, especially in the emergency room. Estimates about the \nconsequences of diagnostic error vary widely and little is known about the factors predicting error. Our \nobjectives thus was to determine the rate of discrepancy between diagnoses at hospital admission and \ndischarge in patients presenting through the emergency room, the discrepancies\xe2\x80\x99 consequences, and factors \npredicting them. \nMethods: Prospective observational clinical study combined with a survey in a University-affiliated tertiary \ncare hospital. Patients\xe2\x80\x99 hospital discharge diagnosis was compared with the diagnosis at hospital admittance \nthrough the emergency room and classified as similar or discrepant according to a predefined scheme by \ntwo independent expert raters. Generalized linear mixed-effects models were used to estimate the effect of \ndiagnostic discrepancy on mortality and length of hospital stay and to determine whether characteristics of \npatients, diagnosing physicians, and context predicted diagnostic discrepancy. \nResults: 755 consecutive patients (322 [42.7%] female; mean age 65.14 years) were included. \nThe discharge diagnosis differed substantially from the admittance diagnosis in 12.3% of cases. Diagnostic \ndiscrepancy was associated with a longer hospital stay (mean 10.29 vs. 6.90 days; Cohen\xe2\x80\x99s d 0.47; 95% \nconfidence interval 0.26 to 0.70; P = 0.002) and increased patient mortality (8 (8.60%) vs. 25(3.78%); OR 2.40; 95% CI 1.05 \nto 5.5 P = 0.038). A factor available at admittance that predicted diagnostic discrepancy was the diagnosing physician\xe2\x80\x99s \nassessment that the patient presented atypically for the diagnosis assigned (OR 3.04; 95% CI 1.33\xe2\x80\x936.96; P = 0.009). \nConclusions: Diagnostic discrepancies are a relevant healthcare problem in patients admitted through the \nemergency room because they occur in every ninth patient and are associated with increased in-hospital \nmortality. Discrepancies are not readily predictable by fixed patient or physician characteristics; attention \nshould focus on context