Diagnostic discrepancies between emergency department admissions and hospital discharges among older adults: secondary analysis on a population-based survey
Autor(a) principal: | |
---|---|
Data de Publicação: | 2020 |
Outros Autores: | |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | São Paulo medical journal (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802020000500359 |
Resumo: | 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. |
id |
APM-1_44e2695b0fb3ad148a865bf87b5bc33e |
---|---|
oai_identifier_str |
oai:scielo:S1516-31802020000500359 |
network_acronym_str |
APM-1 |
network_name_str |
São Paulo medical journal (Online) |
repository_id_str |
|
spelling |
Diagnostic discrepancies between emergency department admissions and hospital discharges among older adults: secondary analysis on a population-based surveyAgedDiagnosisEmergency medicineHospital medicineDiagnostic errorsPatient safetyNHAMCSAtypical presentationClinical assessmentABSTRACT 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.Associação Paulista de Medicina - APM2020-10-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802020000500359Sao Paulo Medical Journal v.138 n.5 2020reponame:São Paulo medical journal (Online)instname:Associação Paulista de Medicinainstacron:APM10.1590/1516-3180.0471.r1.05032020info:eu-repo/semantics/openAccessAvelino-Silva,Thiago JunqueiraSteinman,Michael Alaneng2020-11-13T00:00:00Zoai:scielo:S1516-31802020000500359Revistahttp://www.scielo.br/spmjhttps://old.scielo.br/oai/scielo-oai.phprevistas@apm.org.br1806-94601516-3180opendoar:2020-11-13T00:00São Paulo medical journal (Online) - Associação Paulista de Medicinafalse |
dc.title.none.fl_str_mv |
Diagnostic discrepancies between emergency department admissions and hospital discharges among older adults: secondary analysis on a population-based survey |
title |
Diagnostic discrepancies between emergency department admissions and hospital discharges among older adults: secondary analysis on a population-based survey |
spellingShingle |
Diagnostic discrepancies between emergency department admissions and hospital discharges among older adults: secondary analysis on a population-based survey Avelino-Silva,Thiago Junqueira Aged Diagnosis Emergency medicine Hospital medicine Diagnostic errors Patient safety NHAMCS Atypical presentation Clinical assessment |
title_short |
Diagnostic discrepancies between emergency department admissions and hospital discharges among older adults: secondary analysis on a population-based survey |
title_full |
Diagnostic discrepancies between emergency department admissions and hospital discharges among older adults: secondary analysis on a population-based survey |
title_fullStr |
Diagnostic discrepancies between emergency department admissions and hospital discharges among older adults: secondary analysis on a population-based survey |
title_full_unstemmed |
Diagnostic discrepancies between emergency department admissions and hospital discharges among older adults: secondary analysis on a population-based survey |
title_sort |
Diagnostic discrepancies between emergency department admissions and hospital discharges among older adults: secondary analysis on a population-based survey |
author |
Avelino-Silva,Thiago Junqueira |
author_facet |
Avelino-Silva,Thiago Junqueira Steinman,Michael Alan |
author_role |
author |
author2 |
Steinman,Michael Alan |
author2_role |
author |
dc.contributor.author.fl_str_mv |
Avelino-Silva,Thiago Junqueira Steinman,Michael Alan |
dc.subject.por.fl_str_mv |
Aged Diagnosis Emergency medicine Hospital medicine Diagnostic errors Patient safety NHAMCS Atypical presentation Clinical assessment |
topic |
Aged Diagnosis Emergency medicine Hospital medicine Diagnostic errors Patient safety NHAMCS Atypical presentation Clinical assessment |
description |
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. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-10-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802020000500359 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802020000500359 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1590/1516-3180.0471.r1.05032020 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Associação Paulista de Medicina - APM |
publisher.none.fl_str_mv |
Associação Paulista de Medicina - APM |
dc.source.none.fl_str_mv |
Sao Paulo Medical Journal v.138 n.5 2020 reponame:São Paulo medical journal (Online) instname:Associação Paulista de Medicina instacron:APM |
instname_str |
Associação Paulista de Medicina |
instacron_str |
APM |
institution |
APM |
reponame_str |
São Paulo medical journal (Online) |
collection |
São Paulo medical journal (Online) |
repository.name.fl_str_mv |
São Paulo medical journal (Online) - Associação Paulista de Medicina |
repository.mail.fl_str_mv |
revistas@apm.org.br |
_version_ |
1754209267241451520 |