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Observational Study
. 2023 Apr;18(4):321-328.
doi: 10.1002/jhm.13063. Epub 2023 Feb 13.

Diagnostic delays among COVID-19 patients with a second concurrent diagnosis

Ophir Freund  1 , Lee Azolai  1 , Neta Sror  1 , Idan Zeeman  1 , Tom Kozlovsky  1 , Sharon A Greenberg  2 , Tali Epstein Weiss  1 , Gil Bornstein  1 , Joseph Zvi Tchebiner  1 , Shir Frydman  1
Affiliations
Observational Study

Diagnostic delays among COVID-19 patients with a second concurrent diagnosis

Ophir Freund et al. J Hosp Med. 2023 Apr.

Abstract

Background: Little is known about the effect of a new pandemic on diagnostic errors.

Objective: We aimed to identify delayed second diagnoses among patients presenting to the emergency department (ED) with COVID-19.

Designs: An observational cohort Study.

Settings and participants: Consecutive hospitalized adult patients presenting to the ED of a tertiary referral center with COVID-19 during the Delta and Omicron variant surges. Included patients had evidence of a second diagnosis during their ED stay.

Main outcome and measures: The primary outcome was delayed diagnosis (without documentation or treatment in the ED). Contributing factors were assessed using two logistic regression models.

Results: Among 1249 hospitalized COVID-19 patients, 216 (17%) had evidence of a second diagnosis in the ED. The second diagnosis of 73 patients (34%) was delayed, with a mean (SD) delay of 1.5 (0.8) days. Medical treatment was deferred in 63 patients (86%) and interventional therapy in 26 (36%). The probability of an ED diagnosis was the lowest for Infection-related diagnoses (56%) and highest for surgical-related diagnoses (89%). Evidence for the second diagnosis by physical examination (adjusted odds ratios [AOR] 2.35, 95% confidence interval [CI] 1.20-4.68) or by imaging (AOR 2.10, 95% CI 1.16-3.79) were predictors for ED diagnosis. Low oxygen saturation (AOR 0.38, 95% CI 0.18-0.79) and cough or dyspnea (AOR 0.48, 95% CI 0.25-0.94) in the ED were predictors of a delayed second diagnosis.

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References

REFERENCES

    1. Leape LL, Brennan TA, Laird N, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991;324(6):377-384. doi:10.1056/NEJM199102073240605
    1. Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med. 2005;165(13):1493-1499. doi:10.1001/archinte.165.13.1493
    1. Kachalia A, Gandhi TK, Puopolo AL, et al. Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Ann Emerg Med. 2007;49(2):196-205. doi:10.1016/j.annemergmed.2006.06.035
    1. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003;78(8):775-780. doi:10.1097/00001888-200308000-00003
    1. Gandhi TK, Singh H. Reducing the risk of diagnostic error in the COVID-19 era. J Hosp Med. 2020;15(6):363-366. doi:10.12788/jhm.3461

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