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Observational Study
. 2019 May 8;27(1):54.
doi: 10.1186/s13049-019-0629-z.

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

Wolf E Hautz  1   2 , Juliane E Kämmer  3   4 , Stefanie C Hautz  5 , Thomas C Sauter  5   6 , Laura Zwaan  7 , Aristomenis K Exadaktylos  5 , Tanja Birrenbach  5   8 , Volker Maier  8 , Martin Müller  5 , Stefan K Schauber  9   10
Affiliations
Observational Study

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

Wolf E Hautz et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Diagnostic errors occur frequently, especially in the emergency room. Estimates about the consequences of diagnostic error vary widely and little is known about the factors predicting error. Our objectives thus was to determine the rate of discrepancy between diagnoses at hospital admission and discharge in patients presenting through the emergency room, the discrepancies' consequences, and factors predicting them.

Methods: Prospective observational clinical study combined with a survey in a University-affiliated tertiary care hospital. Patients' hospital discharge diagnosis was compared with the diagnosis at hospital admittance through the emergency room and classified as similar or discrepant according to a predefined scheme by two independent expert raters. Generalized linear mixed-effects models were used to estimate the effect of diagnostic discrepancy on mortality and length of hospital stay and to determine whether characteristics of patients, diagnosing physicians, and context predicted diagnostic discrepancy.

Results: 755 consecutive patients (322 [42.7%] female; mean age 65.14 years) were included. The discharge diagnosis differed substantially from the admittance diagnosis in 12.3% of cases. Diagnostic discrepancy was associated with a longer hospital stay (mean 10.29 vs. 6.90 days; Cohen's d 0.47; 95% confidence 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 to 5.5 P = 0.038). A factor available at admittance that predicted diagnostic discrepancy was the diagnosing physician's assessment that the patient presented atypically for the diagnosis assigned (OR 3.04; 95% CI 1.33-6.96; P = 0.009).

Conclusions: Diagnostic discrepancies are a relevant healthcare problem in patients admitted through the emergency room because they occur in every ninth patient and are associated with increased in-hospital mortality. Discrepancies are not readily predictable by fixed patient or physician characteristics; attention should focus on context.

Trial registration: https://bmjopen.bmj.com/content/6/5/e011585.

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Conflict of interest statement

Ethics approval and consent to participate

The ethics committee of the canton Berne registered the study as a quality evaluation study under No. 197/15 and waived the requirement for informed patient consent. All patients provided a general consent for the use of their data according to Swiss law.

Consent for publication

Not applicable.

Competing interests

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf . WEH reports grant money from the director of research at Inselspital University Hospital Berne and grants from Mittelbauvereinigung of the University of Berne during the conduct of the study; personal fees from AO Foundation Zurich and other from Mundipharma Medical Basel, outside the submitted work. SCH reports grants from Mittelbauvereinigung of the University of Berne, during the conduct of the study and personal fees from AO Foundation Zurich, outside the submitted work. TCS reports grants from Bangerter-Rhyner-Foundation, grants from Boehringer-Ingelheim, grants and personal fees from Bayer, grants from Daiichi-Sankyo and grants from Bristol-Myers Squibb, outside the submitted work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patient flow and outcome
See this image and copyright information in PMC

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