Diagnostic delays among COVID‐19 patients with a second concurrent diagnosis

Abstract

Background: Little is known about the effect of a new pandemic on diagnostic errors. Objective: We aimed to identify delayed second diagnoses among patients presenting to the emergency department (ED) with COVID-19. Designs: An observational cohort Study. Settings and Participants: Consecutive hospitalized adult patients presenting to the ED of a tertiary referral center with COVID-19 during the Delta and Omicron variant surges. Included patients had evidence of a second diagnosis during their ED stay. Main Outcome and Measures: The primary outcome was delayed diagnosis (without documentation or treatment in the ED). Contributing factors were assessed using two logistic regression models.Results: Among 1249 hospitalized COVID-19 patients, 216 (17%) had evidence of a second diagnosis in the ED. The second diagnosis of 73 patients (34%) was delayed, with a mean (SD) delay of 1.5 (0.8) days. Medical treatment was deferred in 63 patients (86%) and interventional therapy in 26 (36%). The probability of an ED diagnosis was the lowest for Infection-related diagnoses (56%) and highest for surgical-related diagnoses (89%). Evidence for the second diagnosis by physical examination (adjusted odds ratios [AOR] 2.35, 95% confidence interval [CI] 1.20-4.68) or by imaging (AOR 2.10, 95% CI 1.16-3.79) were predictors for ED diagnosis. Low oxygen saturation (AOR 0.38, 95% CI 0.18-0.79) and cough or dyspnea (AOR 0.48, 95% CI 0.25-0.94) in the ED were predictors of a delayed second diagnosis.

Post COVID-19 Pandemic Increased Detection of Mycoplasma Pneumoniae in Adults Admitted to the Intensive Care

“…Despite variations observed across multiple studies, previous research conducted prior to the implementation of NPIs for COVID-19 exhibits data that aligns closely with our findings, including extrapulmonary manifestations in severe M. pneumoniae infections like cardiac arrhythmias [ 10 , 11 ]. Alterations in clinical characteristics may suggest a shift in the virulence and pathogenicity of the bacterium.…”

“…In the Netherlands, and other parts of Europe, current empiric first-line treatment regimens for CAP mainly consist of beta-lactam antibiotics such as amoxicillin or cephalosporins, which are ineffective against M. pneumoniae . It is therefore imperative that clinicians have a high index of suspicion for atypical micro-organisms causing CAP such as M. pneumoniae , particularly those with atypical clinical presentations or insufficient response to empiric antibiotic treatment for CAP [ 2 , 5 , 10 , 12 ]. The addition of quinolone treatment, which is advised in the most severe cases of CAP, does not always cover M. pneumoniae in general, as is the case for ciprofloxacin.…”

“…Firstly, empiric treatments for CAP often do not cover M. pneumoniae , potentially leading to inadequate initial therapy [ 7 ]. Secondly, the presence of co-circulating COVID-19 can cause delays in diagnosing M. pneumoniae , particularly if it is not included in the initial respiratory pathogen panel [ 10 ]. Lastly, in some parts of the world, there is a high incidence of marcolide resistance complicating treatment protocols and patient outcomes [ 7 , 11 , 12 ].…”

Factors associated with acute kidney injury (AKI) and mortality in COVID-19 patients in a Sub-Saharan African intensive care unit: a single-center prospective study

“…The use of amikacin also highlights the possibility of superimposed bacterial infection in COVID-19 patients or the existence of concurrent infectious disease which could explain the occurrence of AKI. These two phenomenon was reported in the literature and suggest the need of early diagnosis to possibly prevent AKI [ 51 , 52 ].…”

What to Do When There Is Something Unexpected?

“…As a result, an acute illness, such as a small myocardial infarction that has minor repercussions on overall health, may reveal a more severe diagnosis. Dyspnea and low oxygen saturation are evaluated extensively in the emergency room to the detriment of other symptoms that are often neglected [22,23].…”