Identifying Emergency Department Symptom-Based Diagnoses with the Unified Medical Language System

Slovis, Benjamin H.; McCarthy, Danielle M.; Nord, Garrison; Doty, Amanda; Piserchia, Katherine; Rising, Kristin L.

doi:10.5811//westjem.2019.8.44230

Cited by 7 publications

(7 citation statements)

References 13 publications

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“…A nationally representative study in the United States looking at diagnoses of patients presenting with the three most common ED chief complaints, chest pain, abdominal pain, and headache in ambulatory patients found that 37% of patients were discharged from the ED with a symptomatic instead of a specific pathological diagnosis [ 12 ]. Similarly, unspecific diagnoses (“signs and symptoms”) accounted for over one-third of ED discharge diagnoses of outpatients in a single academic center [ 28 ], and over 20% in an Icelandic investigation [ 17 ]. In a large Danish cohort study of patients brought to the hospital in an ambulance dispatched after emergency calls, unspecific diagnoses accounted for one-third of patients [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Frequency and predictors of unspecific medical diagnoses in the emergency department: a prospective observational study

et al. 2022

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Background Misdiagnosis is a major public health problem, causing increased morbidity and mortality. In the busy setting of an emergency department (ED) patients are diagnosed under difficult circumstances. As a consequence, the ED diagnosis at hospital admittance may often be a descriptive diagnosis, such as “decreased general condition”. Our objective was to determine in how far patients with such an unspecific ED diagnosis differ from patients with a specific ED diagnosis and whether they experience a worse outcome. Methods We conducted a prospective observational study in Bern university hospital in Switzerland for all adult non-trauma patients admitted to any internal medicine ward from August 15th 2015 to December 7th 2015. Unspecific ED diagnoses were defined through the clinical classification software for ICD-10 by two outcome assessors. As outcome parameters, we assessed in-hospital mortality and length of hospital stay. Results Six hundred eighty six consecutive patients were included. Unspecific diagnoses were identified in 100 (14.6%) of all consultations. Patients receiving an unspecific diagnosis at ED discharge were significantly more often women (56.0% vs. 43.9%, p = 0.024), presented more often with a non-specific complaint (34% vs. 21%, p = 0.004), were less often demonstrating an abnormal heart rate (5.0% vs. 12.5%, p = 0.03), and less often on antibiotics (32.0% vs. 49.0%, p = 0.002). Apart from these, no studied drug intake, laboratory or clinical data including change in diagnosis was associated significantly with an unspecific diagnosis. Unspecific diagnoses were neither associated with in-hospital mortality in multivariable analysis (OR = 1.74, 95% CI: 0.60–5.04; p = 0.305) adjusted for relevant confounders nor with length of hospital stay (GMR = 0.87, 95% CI: 0.23–3.32; p = 0.840). Conclusions Women and patients with non-specific presenting complaints and no abnormal heart rate are at risk of receiving unspecific ED diagnoses that do not allow for targeted treatment, discharge and prognosis. This study did not find an effect of such diagnoses on length of hospital stay nor in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Frequency and predictors of unspecific medical diagnoses in the emergency department: a prospective observational study

et al. 2022

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“…Instead, many patients in the ED are discharged with symptom-based discharge diagnoses, and thus linking a subsequent cancer diagnosis to an exact EDvisit is challenging in administrative databases. 23 Thus, our work adds to the current literature by describing the population (in a safety-net setting) that is diagnosed with cancer, and what major cancer types are diagnosed shortly after an ED visit. Lung, pancreatic, colorectal, liver, and kidney cancers are all seen at higher rates in the ED prior to the diagnosis of cancer, suggesting that some undiscovered moderators may be integral to this problem, such as tobacco use among underserved populations.…”

Section: Discussionmentioning

confidence: 99%

“…Since ICD‐coded cancer diagnoses require tissue sample and biopsy, little to no confirmed cancer diagnoses originate from an ED visit. Instead, many patients in the ED are discharged with symptom‐based discharge diagnoses, and thus linking a subsequent cancer diagnosis to an exact ED‐visit is challenging in administrative databases 23 . Thus, our work adds to the current literature by describing the population (in a safety‐net setting) that is diagnosed with cancer, and what major cancer types are diagnosed shortly after an ED visit.…”

Section: Discussionmentioning

confidence: 99%

Worsened outcomes of newly diagnosed cancer in patients with recent emergency care visits: A retrospective cohort study of 3699 adults in a safety net health system

Pettit

Stewart

et al. 2022

Cancer Medicine

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Introduction: Many patients receive a suspected diagnosis of cancer through an emergency department (ED) visit. Time to treatment for a new diagnosis of cancer is directly associated with improved outcomes with little no describing the ED utilization prior to the diagnosis of cancer. We hypothesize that patients that have an ED visit in proximity to a diagnosis of cancer will have worse outcomes, including mortality.Methods: This study is a retrospective cohort study of all patients with cancer diagnosed at Eskenazi Health (Indiana) between 2016 and 2019. Individual health characteristics, ED utilization, cancer types, and mortality were studied. We compared those patients seen in the ED within 6 months prior to their diagnosis (cases) to patients not seen in the ED (controls).Results: A total of 3699 patients with cancer were included, with 1239 cases (33.50%). Patients of black race had higher frequencies in the cases vs. controls (46.57% vs. 40.68%). Lung cancer was the most frequently observed cancer among cases vs. controls (11.70% vs. 5.57%). For the cases, 232 patients were deceased (18.72%) compared with 247 patients among the controls (10.04%, p < 0.0001, OR 2.06 95% confidence interval [CI] 1. 70-2.51). An ED visit in past 6 months (OR = 1.73, 95% CI 1.38-2.18) and Medicaid insurance type (versus commercial, OR = 4.16, 95% CI 2.45-7.07) were associated with of mortality. Female gender (OR = 0.76, 95% CI 0.67-0.88), tobacco use (OR = 1.62, 95% CI 138-1.90), and Medicaid insurance type (versus commercial, OR = 2.56, 95% CI 2.07-3.47) were associated with prior ED use. Conclusions:Over one third of patients with cancer were seen in the ED within 6 months prior to their cancer diagnosis. Higher mortality rates were observed for those seen in the ED. Future studies are needed to investigate the association and impact that the ED has on eventual cancer diagnoses and outcomes.

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“…The relationship between the ED visit and the diagnosis of cancer are unclear, due to lack of detailed ED visit information as well as most patients that are discharged from the ED have symptom-based discharge diagnoses as opposed to a de nitive discharge diagnosis. 41 Additionally, no knowledge is known about previous screenings and primary care follow up, thus no inference can be made to know whether or not screening may have reduced the likelihood of the found associations. The lack of follow-up knowledge means we can't examine the relationship between mortality and inadequate access to expert care, but the correction for clustering on logistic analyses suggests this is not just a result of location.…”

Section: Limitationsmentioning

confidence: 99%

Disparities in Outcomes Among Patients Diagnosed With Cancer in Proximity to an Emergency Department Visit

Pettit

Sarmiento

Kline

2022

Preprint

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A suspected diagnosis of cancer in the emergency department (ED) may be associated with poor outcomes, related to health disparities, however data are limited. This study is a case-control analysis of the Indiana State Department of Health Cancer Registry, and the Indiana Network for Patient Care. First time cancer diagnoses appearing in the registry between January 2013 and December 2017 were included. Cases were patients who had an ED visit in the 6 months before their cancer diagnosis; controls had no recent ED visits. The primary outcome was mortality, comparing ED-associated mortality to non-ED-associated. 134,761 first-time cancer patients were identified, including 15,432 (11.5%) cases. The mean age was same at 65, more of the cases were Black than the controls (12.4% vs 7.4%, P<.0001) and more were low income (36.4%. vs 29.3%). The top 3 ED-associated cancer diagnoses were lung (18.4%), breast (8.9%), and colorectal cancers (8.9%), whereas the controls were breast (17%), lung (14.9%), and prostate cancers (10.1%). Cases observed an over three-fold higher mortality, with cumulative death rate of 32.9% for cases vs 9.0% for controls (P<.0001). Regression analysis predicting mortality, controlling for many confounders produced an odds ratio of 4.12 (95% CI 3.72-4.56 for cases). This study found that an ED visit within 6 months prior to the first time of ICD-coded cancer is associated with Black race, low income and an overall three-fold increased adjusted risk of death. The mortality rates for ED-associated cancers are uniformly worse for all cancer types. These data suggest that additional work is needed to reduce disparities among ED-associated cancer diagnoses.

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Identifying Emergency Department Symptom-Based Diagnoses with the Unified Medical Language System

Cited by 7 publications

References 13 publications

Frequency and predictors of unspecific medical diagnoses in the emergency department: a prospective observational study

Frequency and predictors of unspecific medical diagnoses in the emergency department: a prospective observational study

Worsened outcomes of newly diagnosed cancer in patients with recent emergency care visits: A retrospective cohort study of 3699 adults in a safety net health system

Disparities in Outcomes Among Patients Diagnosed With Cancer in Proximity to an Emergency Department Visit

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