Rate of sepsis hospitalizations after misdiagnosis in adult emergency department patients: a look-forward analysis with administrative claims data using Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) methodology in an integrated health system

Objectives Delays in sepsis diagnosis can increase morbidity and mortality. Previously, we performed a Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) “look-back” analysis to identify symptoms at risk for delayed sepsis diagnosis. We found treat-and-release emergency department (ED) encounters for fluid and electrolyte disorders (FED) and altered mental status (AMS) were associated with downstream sepsis hospitalizations. In this “look-forward” analysis, we measure the potential misdiagnosis-related harm rate for sepsis among patients with these symptoms. Methods Retrospective cohort study using electronic health record and claims data from Kaiser Permanente Mid-Atlantic States (2013–2018). Patients ≥18 years with ≥1 treat-and-release ED encounter for FED or AMS were included. Observed greater than expected sepsis hospitalizations within 30 days of ED treat-and-release encounters were considered potential misdiagnosis-related harms. Temporal analyses were employed to differentiate case and comparison (superficial injury/contusion ED encounters) cohorts. Results There were 4,549 treat-and-release ED encounters for FED or AMS, 26 associated with a sepsis hospitalization in the next 30 days. The observed (0.57%) minus expected (0.13%) harm rate was 0.44% (absolute) and 4.5-fold increased over expected (relative). There was a spike in sepsis hospitalizations in the week following FED/AMS ED visits. There were fewer sepsis hospitalizations and no spike in admissions in the week following superficial injury/contusion ED visits. Potentially misdiagnosed patients were older and more medically complex. Conclusions Potential misdiagnosis-related harms from sepsis are infrequent but measurable using SPADE. This look-forward analysis validated our previous look-back study, demonstrating the SPADE approach can be used to study infectious disease syndromes..

Medienart:	E-Artikel

Erscheinungsjahr:	2021
Erschienen:	2021

Enthalten in:	Zur Gesamtaufnahme - volume:8
Enthalten in:	Diagnosis - 8(2021), 4 vom: 26. Apr., Seite 479-488

Sprache:	Englisch

Beteiligte Personen:	Horberg, Michael A. [VerfasserIn] Nassery, Najlla [VerfasserIn] Rubenstein, Kevin B. [VerfasserIn] Certa, Julia M. [VerfasserIn] Shamim, Ejaz A. [VerfasserIn] Rothman, Richard [VerfasserIn] Wang, Zheyu [VerfasserIn] Hassoon, Ahmed [VerfasserIn] Townsend, Jennifer L. [VerfasserIn] Galiatsatos, Panagis [VerfasserIn] Pitts, Samantha I. [VerfasserIn] Newman-Toker, David E. [VerfasserIn]

Links:	Volltext [lizenzpflichtig]

Anmerkungen:	© 2021 Walter de Gruyter GmbH, Berlin/Boston

doi:	10.1515/dx-2020-0145

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PPN (Katalog-ID):	GRUY007773404