Finkelstein Joseph, Cui Wanting, Ferraro Jeffrey P, Kawamoto Kensaku
Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT.
Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT.
AMIA Jt Summits Transl Sci Proc. 2024 May 31;2024:155-161. eCollection 2024.
The goal of this study was to analyze diagnostic discrepancies between emergency department (ED) and hospital discharge diagnoses in patients with congestive heart failure admitted to the ED. Using a synthetic dataset from the Department of Veterans Affairs, the patients' primary diagnoses were compared at two levels: diagnostic category and body system. With 12,621 patients and 24,235 admission cases, the study found a 58% mismatch rate at the category level, which was reduced to 30% at the body system level. Diagnostic categories associated with higher levels of mismatch included aplastic anemia, pneumonia, and bacterial infections. In contrast, diagnostic categories associated with lower levels of mismatch included alcohol-related disorders, COVID-19, cardiac dysrhythmias, and gastrointestinal hemorrhage. Further investigation revealed that diagnostic mismatches are associated with longer hospital stays and higher mortality rates. These findings highlight the importance of reducing diagnostic uncertainty, particularly in specific diagnostic categories and body systems, to improve patient care following ED admission.
本研究的目的是分析急诊科(ED)收治的充血性心力衰竭患者中,急诊科诊断与医院出院诊断之间的差异。利用退伍军人事务部的合成数据集,在两个层面比较了患者的主要诊断:诊断类别和身体系统。该研究纳入了12621名患者和24235例入院病例,发现在类别层面的不匹配率为58%,在身体系统层面降至30%。与较高不匹配水平相关的诊断类别包括再生障碍性贫血、肺炎和细菌感染。相比之下,与较低不匹配水平相关的诊断类别包括酒精相关障碍、COVID-19、心律失常和胃肠道出血。进一步调查发现,诊断不匹配与更长的住院时间和更高的死亡率相关。这些发现凸显了减少诊断不确定性的重要性,特别是在特定的诊断类别和身体系统中,以改善急诊科收治后患者的护理。