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. 2022 Dec 1;12(12):1066-1072.
doi: 10.1542/hpeds.2022-006593.

Diagnosis Code and Health Care Utilization Patterns Associated With Diagnostic Uncertainty

Trisha L Marshall  1   2 , Philip A Hagedorn  1   2   3   4 , Courtney Sump  1   2 , Chelsey Miller  5 , Matthew Fenchel  6 , Dane Warner  1 , Anna J Ipsaro  1   2 , Peter O'Day  7 , Todd Lingren  4 , Patrick W Brady  1   2   8
Affiliations

Diagnosis Code and Health Care Utilization Patterns Associated With Diagnostic Uncertainty

Trisha L Marshall et al. Hosp Pediatr. .

Abstract

Background and objectives: Diagnostic uncertainty is challenging to identify and study in clinical practice. This study compares differences in diagnosis code and health care utilization between a unique cohort of hospitalized children with uncertain diagnoses (UD) and matched controls.

Patients and methods: This case-control study was conducted at Cincinnati Children's Hospital Medical Center. Cases were defined as patients admitted to the pediatric hospital medicine service and having UDs during their hospitalization. Control patients were matched on age strata, biological sex, and time of year. Outcomes included type of diagnosis codes used (ie, disease- or nondisease-based) and change in code from admission to discharge. Differences in diagnosis codes were evaluated using conditional logistic regression. Health care utilization outcomes included hospital length of stay (LOS), hospital transfer, consulting service utilization, rapid response team activations, escalation to intensive care, and 30-day health care reutilization. Differences in health care utilization were assessed using bivariate statistics.

Results: Our final cohort included 240 UD cases and 911 matched controls. Compared with matched controls, UD cases were 8 times more likely to receive a nondisease-based diagnosis code (odds ratio [OR], 8.0; 95% confidence interval [CI], 5.7-11.2) and 2.5 times more likely to have a change in their primary International Classification of Disease, 10th revision, diagnosis code between admission and discharge (OR, 2.5; 95% CI, 1.9-3.4). UD cases had a longer average LOS and higher transfer rates to our main hospital campus, consulting service use, and 30-day readmission rates.

Conclusions: Hospitalized children with UDs have meaningfully different patterns of diagnosis code use and increased health care utilization compared with matched controls.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest or financial relationships relevant to this article to disclose.

Figures

FIGURE 1
FIGURE 1
Examples of potential changes in International Classification of Diseases, 10th revision, diagnosis codes from admission to discharge. We hypothesized that changes in major diagnostic category were more likely to indicate uncertainty during an acute admission.
See this image and copyright information in PMC

References

    1. Committee on Diagnostic Error in Health Care, Board on Health Care Services, Institute of Medicine, The National Academies of Sciences, Engineering, and Medicine. In: Balogh EP, Miller BT, Ball JR, eds. Improving Diagnosis in Health Care. Washington, DC: National Academies Press; 2015 - PubMed
    1. Hoffman JM, Keeling NJ, Forrest CBet al. . Priorities for pediatric patient safety research. Pediatrics. 2019;143(2):e20180496. - PMC - PubMed
    1. Marshall TL, Rinke ML, Olson APJ, Brady PW. Diagnostic error in pediatrics: a narrative review. Pediatrics. 2022;149(suppl 3):e2020045948D - PubMed
    1. Rinke ML, Singh H, Heo Met al. . Diagnostic errors in primary care pediatrics: project RedDE. Acad Pediatr. 2018;18(2):220–227 - PMC - PubMed
    1. Olson APJ, Graber ML, Singh H. Tracking progress in improving diagnosis: a framework for defining undesirable diagnostic events. J Gen Intern Med. 2018;33(7):1187–1191 - PMC - PubMed

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