Sind Notarztdiagnosen zuverl�ssig?

Arntz, Hans-Richard; Klatt, S.; Stern, Richard; Willich, Stefan N.; Beneker, Jörg

doi:10.1007/s001010050251

Cited by 26 publications

(5 citation statements)

References 16 publications

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“…The proportion of correct diagnoses in patients with specific complaints was assessed in a previous study at our ED, which showed that correct diagnoses were reached in 87% of patients [27]. This is in line with results from other studies in different settings in Europe [19,28,29]. In contrast to patients with NSCs, checklists and diagnostic algorithms are available for patients with specific complaints, and these have been shown to be useful in preventing diagnostic errors [30].…”

Section: Discussionsupporting

confidence: 81%

The proportion of correct diagnoses is low in emergency patients with nonspecific complaints presenting to the emergency department

Peng¹,

Rohacek²,

Ackermann³

et al. 2015

Swiss Med Wkly

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OBJECTIVE: To determine the proportion of correct emergency department (ED) diagnoses and of hospital discharge diagnoses, in comparison with final diagnoses at the end of a 30-day follow-up, in patients presenting with nonspecific complaints (NSCs) to the ED; to determine differences between male and female patients in the proportion of missed diagnoses. METHODS: Prospective observational study. Diagnoses made at the ED, hospital discharge diagnoses, and final diagnoses were compared. RESULTS: Of 22,782 nontrauma patients presenting to the ED from May 2007 until May 2009, 9,926 were triaged as emergency severity index level 2 or 3, of whom 789 presented with NSCs. After exclusion of 217 patients, 572 were included for final analysis. The final diagnosis at the end of follow-up was taken to be the correct "gold standard" diagnosis. In 263 (46.0%) patients, this corresponded to the primary ED diagnosis, and in 292 (51%) patients to the hospital discharge diagnosis. The most frequent final diagnoses were urinary tract infections (n = 49), electrolyte disorders (n = 40) and pneumonia (n = 37), and were correctly diagnosed at the ED in 23, 21 and 27 patients, respectively. Of the twelve most common diagnoses (corresponding to 354 patients), functional impairment was most frequently missed. Among these 354 patients, diagnoses were significantly more often missed in women than in men (142 of 231 [62%] women vs 57 of 123 [46%] men, p = 0.004). CONCLUSION: Patients presenting to the ED with NSCs present a diagnostic challenge. New diagnostic tools are needed to help in the diagnosis of these patients.ClinicalTrials.gov registration number: NCT00920491

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Section: Discussionsupporting

confidence: 81%

The proportion of correct diagnoses is low in emergency patients with nonspecific complaints presenting to the emergency department

Peng¹,

Rohacek²,

Ackermann³

et al. 2015

Swiss Med Wkly

View full text Add to dashboard Cite

show abstract

“…In our study, we observed that 90.6% of the preliminary diagnoses made in the emergency department remained unchanged at patient discharge. This is consistent with the literature and demonstrates the effectiveness of the diagnostic methods used in the emergency department [3][4][5]. This success is even more remarkable when we evaluate it together with the department and diagnosis diversity we see in both tables (Tables 1 and 2).…”

Section: Discussionsupporting

confidence: 89%

“…Additionally, it was noted that in 33% of cases, the patients' admissions to the wards had to be altered. In the study by Arntz et al misdiagnoses that would change the patient's prognosis were found at a similar rate [5]. This is a significant consideration, highlighting the importance of ensuring accurate and definitive diagnoses and admissions from the emergency departments.…”

Section: Discussionmentioning

confidence: 95%

Investigation of the correlation between admission diagnosis and discharge diagnosis in patients transferred from the emergency department to inpatient wards

Turan,

Yazici,

Ekici

et al. 2024

Med-Science

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While some of the patients admitted to emergency departments (ED) are treated and discharged, others are transferred to inpatient services. The follow-up of these transferred patients is mostly based on their hospitalization diagnosis. It is important that the hospitalization diagnosis is accurate and reliable. We aimed to examine whether there is a difference between the diagnosis of admission in the emergency department and the diagnosis used at discharge from the hospital during one week. After excluding patients who were admitted without being evaluated in the emergency department and patients with missing data, a total of 544 patients were included. It was observed that most admissions were made to the internal medicine unit (n=118). When it was analyzed whether the diagnosis changed, it was observed that 90.6% of the patients maintained the same diagnosis after discharge. When the tests that led to a change in diagnosis were analyzed, it was found that CT and MRI played the most important role. Although the tests performed led to a change in the hospitalization diagnosis, only 33% of the patients had a change in the hospitalization episode. This is an important point and emphasizes the importance of ensuring accurate and precise diagnoses and admissions from emergency departments. In conclusion, these findings point to the need for improvements in the diagnostic and treatment processes of patients transferred from the ED to the wards. In this way, it will be possible to improve the clinical outcomes of patients and ensure efficient use of resources.

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“…The reasons for diagnostic discrepancies include, but are not limited to, a switch from a general diagnosis to a more specific one in relevant fields, grossly incorrect initial impressions due to various reasons, an over- or under-estimation of disease severity, and others222325. We discovered that most elderly patients with a diagnostic discrepancy were found to have unrelated diagnoses (39%), while a switch from general to specific diagnosis accounted for 36% of the cases (Fig.…”

Section: Discussionmentioning

confidence: 83%

“…A more recent study comparing the diagnoses made by emergency physicians to those made upon discharge discovered that 7% to 10% of admissions contained clinically important diagnostic discrepancies22. Similarly, Heuer et al .…”

Section: Discussionmentioning

confidence: 95%

Acute kidney injury as a risk factor for diagnostic discrepancy among geriatric patients: a pilot study

Chao

Tsai

Chiang

et al. 2016

Sci Rep

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Diagnostic discrepancy, defined as different admission and discharge diagnoses, could be a potential source of diagnostic error. We evaluated whether acute kidney injury (AKI) in the elderly affected their risk for diagnostic discrepancy. Patients aged ≥60 years from the general medical wards were prospectively enrolled and divided according to AKI status upon admission, using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We compared their discharge and admission diagnoses and identified patients with a diagnostic discrepancy, using multiple logistic regression analysis to evaluate the relationship between initial AKI and the presence of a diagnostic discrepancy. A total of 188 participants (mean age, 77.9 years) were recruited. Regression analysis showed that initial AKI on admission was associated with a higher risk of diagnostic discrepancy upon discharge (odds ratio [OR] 3.3; p < 0.01). In contrast, higher AKI severity was also associated with an increased risk of diagnostic discrepancy (for KDIGO grade 1, 2, and 3; OR 2.92, 3.91, and 4.32; p = 0.04, 0.03, and 0.02, respectively), suggesting that initial AKI upon admission could be an important risk factor for diagnostic discrepancy. Consequently, reducing geriatric AKI might have the potential to reduce diagnostic discrepancy among these patients.

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Sind Notarztdiagnosen zuverl�ssig?

Cited by 26 publications

References 16 publications

The proportion of correct diagnoses is low in emergency patients with nonspecific complaints presenting to the emergency department

The proportion of correct diagnoses is low in emergency patients with nonspecific complaints presenting to the emergency department

Investigation of the correlation between admission diagnosis and discharge diagnosis in patients transferred from the emergency department to inpatient wards

Acute kidney injury as a risk factor for diagnostic discrepancy among geriatric patients: a pilot study

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