Misdiagnosis and quality of management in paediatric surgical patients referred to a tertiary care hospital.

BACKGROUND

The literature on diagnosis and management prior to transfer paediatric surgical patients to a tertiary care center is scarce. In referral centers, it is common to receive patients previously subjected to inadequate or inappropriate health care.

AIM

Analyze the prevalence of misdiagnosis and quality of management in patients before being referred and factors related to misdiagnosis and inadequate management.

DESIGN

Prospective, longitudinal, comparative study between patients with appropriate and inappropriate submission diagnosis and between patients with adequate or inadequate treatment.

SETTING

Third level care hospital, Mexico City.

PARTICIPANTS

Newborn to adolescents referred to Paediatric Surgery Department.

INTERVENTION(S): None.

MAIN OUTCOME MEASURE(S): Misdiagnosis and quality of management prior to being referred.

RESULT

Two hundred patients were evaluated. Correlation between submission diagnosis and final diagnosis showed that 70% were correct and 30% incorrect; 48.5% were properly managed and 51.5% inappropriately managed. Incorrect diagnosis was more frequent when referred from first-or second-level hospitals and in inflammatory conditions. Patients referred by paediatricians had a higher rate of adequate management.

CONCLUSION

We present the frequency of incorrect diagnosis and inadequate patient management in a highly selected population. Sample size should be increased as well as performing these studies in other hospital settings in order to determine whether the results are reproducible.