التفاصيل البيبلوغرافية
| العنوان: |
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. |
| المؤلفون: |
Horberg, Michael A., Nassery, Najlla, Rubenstein, Kevin B., Certa, Julia M., Shamim, Ejaz A., Rothman, Richard, Wang, Zheyu, Hassoon, Ahmed, Townsend, Jennifer L., Galiatsatos, Panagis, Pitts, Samantha I., Newman-Toker, David E. |
| المصدر: |
Diagnosis (2194-802X); Nov2021, Vol. 8 Issue 4, p479-488, 10p |
| مصطلحات موضوعية: |
DIAGNOSTIC errors, ADULTS, SEPSIS, HOSPITAL emergency services, HOSPITAL care, NEONATAL sepsis, MOUNTAIN sickness |
| مصطلحات جغرافية: |
MIDDLE Atlantic States |
| الشركة/الكيان: |
KAISER Permanente (Company) |
| مستخلص: |
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. 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. 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. 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. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
