Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality

Manish Bastakoti; Mohamad Muhailan; Ahmad Nassar; Tariq Sallam; Sameer Desale; Ragai Fouda; Hussam Ammar; Carmella Cole

doi:10.1515/dx-2021-0001

Article

Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality

Manish Bastakoti , Mohamad Muhailan , Ahmad Nassar , Tariq Sallam , Sameer Desale , Ragai Fouda , Hussam Ammar and Carmella Cole

Published/Copyright: July 5, 2021

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From the journal Diagnosis Volume 9 Issue 1

Abstract

Objectives

Published discrepancy rates between emergency department (ED) and hospital discharge (HD) diagnoses vary widely (from 6.5 to 75.6%). The goal of this study was to determine the extent of diagnostic discrepancy and its impact on length of hospital stay (LOS), up-triage to the intensive care unit (ICU) and in-hospital mortality.

Methods

A retrospective chart review of adult patients admitted from the ED to a hospitalist service at a tertiary hospital was performed. The ED and HD diagnoses were compared and classified as concordant, discordant, or symptom diagnoses according to predefined criteria. Logistic regression analysis was conducted to examine the associations of diagnostic discordance with in-hospital mortality and up-triage to the ICU. A linear regression model was used for the length of stay.

Results

Of the 636 patients whose records were reviewed, 418 (217 [51.9%] women, with a mean age of 64.1 years) were included. Overall, 318 patients (76%) had concordant diagnoses, while 91 (21.77%) had discordant diagnoses. Only 9 patients (2.15%) had symptom diagnoses. A discordant diagnosis was associated with increased mortality (OR: 3.64; 95% CI: 1.026–12.91; p=0.045) and up-triage to the ICU (OR: 5.51; 95% CI: 2.43–12.5; p<0.001). The median LOS was significantly greater for patients with discordant diagnoses (7 days) than for those with concordant diagnoses (4.7 days) (p=0.004). Symptom diagnosis did not affect the mortality or ICU up-triage.

Conclusions

One in five hospitalized patients had discordant HD and admission diagnoses. This diagnostic discrepancy was associated with significant impacts on patient morbidity and mortality.

Keywords: concordant diagnoses; diagnostic discrepancy; diagnostic errors; discordant diagnoses; emergency department diagnosis; hospital diagnosis

Corresponding author: Hussam Ammar, MD, Attending Physician, Internal Medicine Department, MedStar Washington Hospital Center, 110 Irving St NW, Suite 1A50A, Washington, DC 20010, USA, Tel: 202-877-2835, E-mail: Hussam.ammar@medstar.net

Funding source: Graduate Medical Education program at MedStar Washington Hospital Center

Acknowledgments

We thank Fred King, MSLS, AHIP Medical Librarian, MedStar Washington Hospital Center, for performing the literature search and for his assistance throughout this work. We also thank American Journal Experts (AJE) for manuscript editing.

Research funding: The study was funded by the Graduate Medical Education program at MedStar Washington Hospital Center.
Author contributions: CC conceptualized the study and critically reviewed the manuscript. HA, MB, MM, TS, and AN collected the data, researched the literature, and wrote and reviewed the manuscript. SD performed the statistical analysis. RF reviewed the literature and wrote and reviewed the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Not Applicable.
Ethical approval: The MedStar Health Research Institute deemed the study exempt from review.

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Received: 2021-01-03

Accepted: 2021-06-03

Published Online: 2021-07-05

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Articles in the same Issue

https://doi.org/10.1515/dx-2021-0001

Keywords for this article

concordant diagnoses; diagnostic discrepancy; diagnostic errors; discordant diagnoses; emergency department diagnosis; hospital diagnosis