Incidence, Duration, and Risk Factors Associated With Missed Opportunities to Diagnose Herpes Simplex Encephalitis: A Population-Based Longitudinal Study

Koeneman, Scott H.; Arakkal, Alan; Cavanaugh, Joseph E.; Polgreen, Philip M.

doi:10.1093/ofid/ofab400

Cited by 11 publications

(14 citation statements)

References 35 publications

(29 reference statements)

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“…To estimate the number of missed opportunities to diagnose NSTIG, we used a type of case-crossover analysis and a simulation-based method 20 that have been previously used to study diagnostic delays in administrative data. [21][22][23] We first estimated the expected pattern of SSDassociated visits prior to the diagnostic-opportunity window. We then computed the number of likely missed diagnostic opportunities as the difference between the observed and expected number of SSD-associated visits during the diagnostic opportunity window.…”

Section: Frequency and Duration Of Diagnostic Delaysmentioning

confidence: 99%

Understanding the Prodromal Period of Necrotizing Soft Tissue Infections of the Genitalia (Fournier’s Gangrene) and the Incidence, Duration, and Risk Factors Associated With Potential Missed Opportunities for an Earlier Diagnosis: A Population-based Longitudinal Study

et al. 2022

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The purpose of this paper was to investigate patterns of health care utilization leading up to diagnosis of necrotizing soft tissue infections of the genitalia and to identify risk factors associated with potential diagnostic delay. Materials and Methods: IBM MarketScan Research Databases (2001Databases ( -2020 were used to identify index cases of necrotizing soft tissue infections of the genitalia. We identified health care visits for symptomatically similar diagnoses (eg, penile swelling, cellulitis) that occurred prior to necrotizing soft tissue infections of the genitalia diagnosis. A change-point analysis identified the window before diagnosis where diagnostic opportunities first appeared. A simulation model estimated the likelihood symptomatically similar diagnosis visits represented a missed opportunity for earlier diagnosis. Patient and provider characteristics were evaluated for their associations with delay. Results: We identified 8,098 patients with necrotizing soft tissue infections of the genitalia, in which 4,032 (50%) had a symptomatically similar diagnosis visit in the 21-day diagnostic window, most commonly for "non-infectious urologic abnormalities" (eg, genital swelling; 64%): 46% received antibiotics; 16% saw a urologist. Models estimated that 5,096 of the symptomatically similar diagnosis visits (63%) represented diagnostic delay (mean duration 6.2 days; mean missed opportunities 1.8). Risk factors for delay included urinary tract infection history (OR 2.1) and morbid obesity (OR 1.6). Visits to more than 1 health care provider/ location in a 24-hour period significantly decreased delay risk. Conclusions: Nearly 50% of insured patients who undergo debridement for, or die from, necrotizing soft tissue infections of the genitalia will present to a medical provider with a symptomatically similar diagnosis suggestive of early disease development. Many of these visits likely represent diagnostic delay. Efforts to minimize logistic and cognitive biases in this rare condition may lead to improved outcomes if they lead to earlier interventions.

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Section: Frequency and Duration Of Diagnostic Delaysmentioning

confidence: 99%

Understanding the Prodromal Period of Necrotizing Soft Tissue Infections of the Genitalia (Fournier’s Gangrene) and the Incidence, Duration, and Risk Factors Associated With Potential Missed Opportunities for an Earlier Diagnosis: A Population-based Longitudinal Study

et al. 2022

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“…First, we estimated the frequency and duration of diagnostic delays for pertussis by applying a bootstrapping approach previously utilized to identify missed diagnostic opportunities for infectious diseases in claims data. [20][21][22] Second, we used a regression analysis to evaluate risk factors for experiencing a possible missed diagnostic opportunity. For both analyses, we start by identifying potential diagnostic delays by looking for symptomatically similar diagnoses (SSDs) that occurred during healthcare visits prior to the index pertussis diagnosis.…”

Section: Discussionmentioning

confidence: 99%

The incidence, duration, risk factors, and age-based variation of missed opportunities to diagnose pertussis: A population-based cohort study

Evans

Arakkal

Cavanaugh

et al. 2023

Infect. Control Hosp. Epidemiol.

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Objective: To estimate the incidence, duration and risk factors for diagnostic delays associated with pertussis. Design: We used longitudinal retrospective insurance claims from the Marketscan Commercial Claims and Encounters, Medicare Supplemental (2001–2020), and Multi-State Medicaid (2014–2018) databases. Setting: Inpatient, emergency department, and outpatient visits. Patients: The study included patients diagnosed with pertussis (International Classification of Diseases [ICD] codes) and receipt of macrolide antibiotic treatment. Methods: We estimated the number of visits with pertussis-related symptoms before diagnosis beyond that expected in the absence of diagnostic delays. Using a bootstrapping approach, we estimated the number of visits representing a delay, the number of missed diagnostic opportunities per patient, and the duration of delays. Results were stratified by age groups. We also used a logistic regression model to evaluate potential factors associated with delay. Results: We identified 20,828 patients meeting inclusion criteria. On average, patients had almost 2 missed opportunities prior to diagnosis, and delay duration was 12 days. Across age groups, the percentage of patients experiencing a delay ranged from 29.7% to 37.6%. The duration of delays increased considerably with age from an average of 5.6 days for patients aged <2 years to 13.8 days for patients aged ≥18 years. Factors associated with increased risk of delays included emergency department visits, telehealth visits, and recent prescriptions for antibiotics not effective against pertussis. Conclusions: Diagnostic delays for pertussis are frequent. More work is needed to decrease diagnostic delays, especially among adults. Earlier case identification may play an important role in the response to outbreaks by facilitating treatment, isolation, and improved contact tracing.

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“…Our analysis aimed to address two primary objectives: (1) determine the frequency and duration of diagnostic delays associated with histoplasmosis, and (2) estimate risk factors for a potential missed diagnostic opportunity. We used a previously developed simulation-based approach to identify missed diagnostic opportunities that employs a case-crossover type design, where each case patient serves as their own control during the period before presence of clinical disease (i.e., histoplasmosis) occurs [ 26 , 27 ]. This approach builds upon other studies to identify delays in longitudinal administrative claims data [ 28 , 29 ].…”

Section: Methodsmentioning

confidence: 99%

“…A bootstrapping procedure is then used to compute metrics associated with diagnostic delays. Additional details of this approach can be found in [ 26 , 27 ].…”

Section: Methodsmentioning

confidence: 99%

Frequency and Duration of, and Risk Factors for, Diagnostic Delays Associated with Histoplasmosis

Arakkal

Koeneman

Cavanaugh

et al. 2022

JoF

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Histoplasmosis is often confused with other diseases leading to diagnostic delays. We estimated the incidence, length of, and risk factors for, diagnostic delays associated with histoplasmosis. Using data from IBM Marketscan, 2001–2017, we found all patients with a histoplasmosis diagnosis. We calculated the number of visits that occurred prior to the histoplasmosis diagnosis and the number of visits with symptomatically similar diagnoses (SSDs). Next, we estimated the number of visits that represented a delay using a simulation-based approach. We also computed the number of potential opportunities for diagnosis that were missed for each patient and the length of time between the first opportunity and the diagnosis. Finally, we identified risk factors for diagnostic delays using a logistic regression model. The number of SSD-related visits increased significantly in the 97 days prior to the histoplasmosis diagnosis. During this period, 97.4% of patients had a visit, and 90.1% had at least one SSD visit. We estimate that 82.9% of patients with histoplasmosis experienced at least one missed diagnostic opportunity. The average delay was 39.5 days with an average of 4.0 missed opportunities. Risk factors for diagnostic delays included prior antibiotic use, history of other pulmonary diseases, and emergency department and outpatient visits, especially during weekends. New diagnostic approaches for histoplasmosis are needed.

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Incidence, Duration, and Risk Factors Associated With Missed Opportunities to Diagnose Herpes Simplex Encephalitis: A Population-Based Longitudinal Study

Cited by 11 publications

References 35 publications

Understanding the Prodromal Period of Necrotizing Soft Tissue Infections of the Genitalia (Fournier’s Gangrene) and the Incidence, Duration, and Risk Factors Associated With Potential Missed Opportunities for an Earlier Diagnosis: A Population-based Longitudinal Study

Understanding the Prodromal Period of Necrotizing Soft Tissue Infections of the Genitalia (Fournier’s Gangrene) and the Incidence, Duration, and Risk Factors Associated With Potential Missed Opportunities for an Earlier Diagnosis: A Population-based Longitudinal Study

The incidence, duration, risk factors, and age-based variation of missed opportunities to diagnose pertussis: A population-based cohort study

Frequency and Duration of, and Risk Factors for, Diagnostic Delays Associated with Histoplasmosis

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