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Assessment of the frequency and possible causes of mismatch between initial and final diagnosis in the emergency department of Baqiyatallah Hospital
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Hasan Goudarzi   , Mahdi Naeeemaniali , Sadrollah Mahmoodi * |
| Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. , sadrollah.mahmoudi@gmail.com |
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Abstract: (1119 Views) |
Introduction: Diagnostic discrepancy means the inconsistency between the diagnosis made by the emergency medicine specialist in the first step of the patient's visit and the final diagnosis made by the specialists of other fields after admission to the emergency room or hospital. This study investigates the frequency and possible factors related to the discrepancy between the initial and final diagnosis in the emergency department of Baqiyatallah Hospital.
Methods: In a cross-sectional study conducted in 2023, the initial and final diagnoses in the emergency file of hospitalized patients were examined. The final diagnosis was obtained by studying the summary of patients' files or the results of paraclinical tests, including routine clinical tests on peripheral blood, interpretation of pathology samples, radiology reports, and other procedures performed for the patient or after surgery. A comparison was made between the initial diagnosis or the initial symptomatic diagnosis and the final diagnosis, and the frequency of diagnostic mismatch was obtained.
Results: Out of 246 samples of this study, 70 cases of primary diagnosis were symptomatic, and the rest were primary definitive diagnoses. The highest frequency of consultations was related to internal medicine, followed by pediatrics. The average number of patients visited by each doctor was 316.3 cases. The average number of emergency specialists in two months was 16.5. Considering the significance level of 5% and using chi-square and Mann-Whitney tests, between all independent variables, patient age and category of disease had a significant relationship with the frequency of diagnostic mismatch that most of the diagnostic discrepancies occurred in the age of over 50 years. The highest rate of diagnostic mismatch was in cardiology, with 47.2%, and infectious disease, with 44.4%. General and pediatric surgery fields had the lowest rate of diagnostic mismatch and the highest diagnostic accuracy.
Conclusion: In general, the rate of diagnostic mismatch in the emergency room is higher than in other conditions. Factors such as the patient's age and the disease's nature or category expose the emergency medicine specialist to errors and misdiagnosis. Although the primary duty of emergency physicians is damage control and critical care medicine, they do not make definite diagnoses. |
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| Keywords: Diagnostic mismatch, symptomatic diagnosis, emergency medicine. |
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Full-Text [PDF 514 kb]
(501 Downloads)
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Type of Study: Original Article |
Subject:
Marine Medicine
Received: 2023/09/24 | Accepted: 2024/05/6 | Published: 2024/05/30
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