TY - JOUR
T1 - Diagnostic delays among COVID-19 patients with a second concurrent diagnosis
AU - Freund, Ophir
AU - Azolai, Lee
AU - Sror, Neta
AU - Zeeman, Idan
AU - Kozlovsky, Tom
AU - Greenberg, Sharon A.
AU - Epstein Weiss, Tali
AU - Bornstein, Gil
AU - Tchebiner, Joseph Zvi
AU - Frydman, Shir
N1 - Publisher Copyright:
© 2023 The Authors. Journal of Hospital Medicine published by Wiley Periodicals LLC on behalf of Society of Hospital Medicine.
PY - 2023/4
Y1 - 2023/4
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85148035331&partnerID=8YFLogxK
U2 - 10.1002/jhm.13063
DO - 10.1002/jhm.13063
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
C2 - 36779316
AN - SCOPUS:85148035331
SN - 1553-5592
VL - 18
SP - 321
EP - 328
JO - Journal of Hospital Medicine
JF - Journal of Hospital Medicine
IS - 4
ER -