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Harbingers of sepsis misdiagnosis among pediatric emergency department patients

  • Jonathan G. Sawicki ORCID logo EMAIL logo , Jessica Graham , Gitte Larsen and Jennifer K. Workman
Published/Copyright: December 12, 2024
Diagnosis
From the journal Diagnosis Volume 12 Issue 2

Abstract

Objectives

To identify clinical presentations that acted as harbingers for future sepsis hospitalizations in pediatric patients evaluated in the emergency department (ED) using the Symptom Disease Pair Analysis of Diagnostic Error (SPADE) methodology.

Methods

We identified patients in the Pediatric Health Information Systems (PHIS) database admitted for sepsis between January 1, 2004 and December 31, 2023 and limited the study cohort to those patients who had an ED treat-and-release visit in the 30 days prior to admission. Using the look-back approach of the SPADE methodology, we identified the most common clinical presentations at the initial ED visit and used an observed to expected (O:E) analysis to determine which presentations were overrepresented. We then employed a graphical, temporal analysis with a comparison group to identify which overrepresented presentations most likely represented harbingers for future sepsis hospitalization.

Results

We identified 184,157 inpatient admissions for sepsis, of which 15,331 hospitalizations (8.3 %) were preceded by a treat-and-release ED visit in the prior 30 days. Based on the O:E and temporal analyses, the presentations of fever and dehydration were both overrepresented in the study cohort and temporally clustered close to sepsis hospitalization. ED treat-and-release visits for fever or dehydration preceded 1.2 % of all sepsis admissions.

Conclusions

In pediatric patients presenting to the ED, fever and dehydration may represent harbingers for future sepsis hospitalization. The SPADE methodology could be applied to the PHIS database to develop diagnostic performance measures across a wide range of pediatric hospitals.

Keywords: pediatrics; diagnostic error; sepsis; misdiagnosis related harms
Corresponding author: Jonathan G. Sawicki, MD, MSCI, Department of Pediatrics, University of Utah School of Medicine, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113 USA, E-mail:

  1. Research ethics: The local Institutional Review Board deemed the study to be non-human subjects research.

  2. Informed consent: Not applicable.

  3. Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: None declared.

  7. Data availability: The raw data can be obtained on request from the corresponding author.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/dx-2024-0119).

Received: 2024-07-09
Accepted: 2024-11-04
Published Online: 2024-12-12

© 2024 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Pioneering diagnosis in Asia: advancing clinical reasoning expertise through the lens of 3M
  4. Short Communication
  5. The foundations of the diagnostic error movement: a tribute to Eta Berner, PhD
  6. Reviews
  7. Interventions to improve timely cancer diagnosis: an integrative review
  8. Technical aspects and clinical applications of synthetic MRI: a scoping review
  9. Mini Review
  10. Challenges and barriers for the adoption of personalized medicine in Europe: the case of Oncotype DX Breast Recurrence Score® test
  11. Opinion Papers
  12. Beyond thinking fast and slow: a Bayesian intuitionist model of clinical reasoning in real-world practice
  13. Diagnostic scope: the AI can’t see what the mind doesn’t know
  14. Guidelines and Recommendations
  15. CDC’s Core Elements to promote diagnostic excellence
  16. Original Articles
  17. Trends of diagnostic adverse events in hospital deaths: longitudinal analyses of four retrospective record review studies
  18. The effect of a provisional diagnosis on intern diagnostic reasoning: a mixed methods study
  19. On context specificity and management reasoning: moving beyond diagnosis
  20. Diagnostic errors in patients admitted directly from new outpatient visits
  21. Breaking the guidelines: how financial unawareness fuels guideline deviations and inefficient DVT diagnostics
  22. Harbingers of sepsis misdiagnosis among pediatric emergency department patients
  23. Factors affecting diagnostic difficulties in aseptic meningitis: a retrospective observational study
  24. Prenatal diagnostic errors in hemoglobin Bart’s hydrops fetalis caused by rare genetic interactions of α-thalassemia
  25. Screening fasting glucose before the OGTT: near-patient glucometer- or laboratory-based measurement?
  26. Three-way comparison of different ESR measurement methods and analytical performance assessment of TEST1 automated ESR analyzer
  27. Short Communications
  28. Medical language matters: impact of clinical summary composition on a generative artificial intelligence’s diagnostic accuracy
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https://doi.org/10.1515/dx-2024-0119
Keywords for this article
pediatrics; diagnostic error; sepsis; misdiagnosis related harms

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Pioneering diagnosis in Asia: advancing clinical reasoning expertise through the lens of 3M
  4. Short Communication
  5. The foundations of the diagnostic error movement: a tribute to Eta Berner, PhD
  6. Reviews
  7. Interventions to improve timely cancer diagnosis: an integrative review
  8. Technical aspects and clinical applications of synthetic MRI: a scoping review
  9. Mini Review
  10. Challenges and barriers for the adoption of personalized medicine in Europe: the case of Oncotype DX Breast Recurrence Score® test
  11. Opinion Papers
  12. Beyond thinking fast and slow: a Bayesian intuitionist model of clinical reasoning in real-world practice
  13. Diagnostic scope: the AI can’t see what the mind doesn’t know
  14. Guidelines and Recommendations
  15. CDC’s Core Elements to promote diagnostic excellence
  16. Original Articles
  17. Trends of diagnostic adverse events in hospital deaths: longitudinal analyses of four retrospective record review studies
  18. The effect of a provisional diagnosis on intern diagnostic reasoning: a mixed methods study
  19. On context specificity and management reasoning: moving beyond diagnosis
  20. Diagnostic errors in patients admitted directly from new outpatient visits
  21. Breaking the guidelines: how financial unawareness fuels guideline deviations and inefficient DVT diagnostics
  22. Harbingers of sepsis misdiagnosis among pediatric emergency department patients
  23. Factors affecting diagnostic difficulties in aseptic meningitis: a retrospective observational study
  24. Prenatal diagnostic errors in hemoglobin Bart’s hydrops fetalis caused by rare genetic interactions of α-thalassemia
  25. Screening fasting glucose before the OGTT: near-patient glucometer- or laboratory-based measurement?
  26. Three-way comparison of different ESR measurement methods and analytical performance assessment of TEST1 automated ESR analyzer
  27. Short Communications
  28. Medical language matters: impact of clinical summary composition on a generative artificial intelligence’s diagnostic accuracy
  29. Impact of meta-memory techniques in generating effective differential diagnoses in a pediatric core clerkship
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