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
© 2021 Walter de Gruyter GmbH, Berlin/Boston..
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 |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:8 |
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| Enthalten in: |
Diagnosis (Berlin, Germany) - 8(2021), 4 vom: 25. Nov., Seite 479-488 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Horberg, Michael A [VerfasserIn] |
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| Links: |
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| Themen: |
Delirium |
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| Anmerkungen: |
Date Completed 03.12.2021 Date Revised 14.12.2021 published: Electronic-Print Citation Status MEDLINE |
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| doi: |
10.1515/dx-2020-0145 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM324476787 |
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| 100 | 1 | |a Horberg, Michael A |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Rate of sepsis hospitalizations after misdiagnosis in adult emergency department patients |b a look-forward analysis with administrative claims data using Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) methodology in an integrated health system |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 03.12.2021 | ||
| 500 | |a Date Revised 14.12.2021 | ||
| 500 | |a published: Electronic-Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021 Walter de Gruyter GmbH, Berlin/Boston. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a delirium | |
| 650 | 4 | |a diagnostic error | |
| 650 | 4 | |a emergency medical services | |
| 650 | 4 | |a health services research | |
| 650 | 4 | |a sepsis | |
| 650 | 4 | |a water-electrolyte balance | |
| 700 | 1 | |a Nassery, Najlla |e verfasserin |4 aut | |
| 700 | 1 | |a Rubenstein, Kevin B |e verfasserin |4 aut | |
| 700 | 1 | |a Certa, Julia M |e verfasserin |4 aut | |
| 700 | 1 | |a Shamim, Ejaz A |e verfasserin |4 aut | |
| 700 | 1 | |a Rothman, Richard |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Zheyu |e verfasserin |4 aut | |
| 700 | 1 | |a Hassoon, Ahmed |e verfasserin |4 aut | |
| 700 | 1 | |a Townsend, Jennifer L |e verfasserin |4 aut | |
| 700 | 1 | |a Galiatsatos, Panagis |e verfasserin |4 aut | |
| 700 | 1 | |a Pitts, Samantha I |e verfasserin |4 aut | |
| 700 | 1 | |a Newman-Toker, David E |e verfasserin |4 aut | |
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