Uncertain diagnoses in a children’s hospital: patient characteristics and outcomes
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Courtney A. Sump
,
Trisha L. Marshall
Abstract
Background
A quality improvement initiative at our institution resulted in a new process for prospectively identifying pediatric hospital medicine (PHM) patients with uncertain diagnoses (UD). This study describes the clinical characteristics and healthcare utilization patterns of patients with UD.
Methods
This single center cross-sectional study included all PHM patients identified with UD during their admission. A structured chart review was used to abstract patient demographics, primary symptoms, discharge diagnoses, and healthcare utilization patterns, including consult service use, length of stay (LOS), escalation in care, and 30-day healthcare reutilization. Appropriate descriptive statistics were used for categorical and continuous variables.
Results
This study includes 200 PHM patients identified with UD. Gastrointestinal symptoms were the primary finding in 45% of patients with UD. Consult service use was highly variable, with a range of 0–8 consult services for individual patients. The median LOS was 1.6 days and only 5% required a rapid response team evaluation. As for reutilization, 7% of patients were readmitted within 30 days.
Conclusions
This descriptive study highlights the heterogeneity of patients with uncertain diagnoses. Ongoing work is needed to further understand the impact of UD and to optimize the care of these patients.
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Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
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Research funding: None declared.
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Employment or leadership: None declared.
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Honorarium: None declared.
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Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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©2020 Walter de Gruyter GmbH, Berlin/Boston
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Articles in the same Issue
- Frontmatter
- Editorial
- Chest pain management and biomarkers: the lack of trust in cardiac troponins measurement
- Reviews
- Bringing the clinical laboratory into the strategy to advance diagnostic excellence
- Atrial fibrillation: is there a role for cardiac troponin?
- Opinion Papers
- Towards better metainterpretation: improving the clinician’s interpretation of the radiology report
- The challenges of diagnosing diabetes in childhood
- Guidelines and Recommendations
- Measuring patient experience of diagnostic care and acceptability of testing
- Original Articles
- Clinical assessment of the Roche SARS-CoV-2 rapid antigen test
- Delayed treatment of bacteremia during the COVID-19 pandemic
- Strengths and weaknesses in the diagnostic process of endometriosis from the patients’ perspective: a focus group study
- Identifying trigger concepts to screen emergency department visits for diagnostic errors
- Handshake antimicrobial stewardship as a model to recognize and prevent diagnostic errors
- Uncertain diagnoses in a children’s hospital: patient characteristics and outcomes
- The effects of rudeness, experience, and perspective-taking on challenging premature closure after pediatric ICU physicians receive hand-off with the wrong diagnosis: a randomized controlled simulation trial
- Resident-faculty overnight discrepancy rates as a function of number of consecutive nights during a week of night float
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- Short Communication
- Chest pain management: use of troponins in internal medicine wards
- Case Report
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- Letters to the Editor
- Usability of non-medicinal swabs for SARS-CoV-2 detection to circumvent supply shortages
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