Diagnostic error increases mortality and length of hospital stay in patients presenting through the emergency room.

Hautz, Wolf; Kämmer, Juliane E; Hautz, Stefanie; Sauter, Thomas; Zwaan, Laura; Exadaktylos, Aristomenis; Birrenbach, Tanja Nicole; Maier, Volker; Müller, Martin; Schauber, Stefan K (2019). Diagnostic error increases mortality and length of hospital stay in patients presenting through the emergency room. Scandinavian journal of trauma, resuscitation and emergency medicine, 27(1), p. 54. BioMed Central 10.1186/s13049-019-0629-z

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BACKGROUND Diagnostic errors occur frequently, especially in the emergency room. Estimates about the consequences of diagnostic error vary widely and little is known about the factors predicting error. Our objectives thus was to determine the rate of discrepancy between diagnoses at hospital admission and discharge in patients presenting through the emergency room, the discrepancies' consequences, and factors predicting them. METHODS Prospective observational clinical study combined with a survey in a University-affiliated tertiary care hospital. Patients' hospital discharge diagnosis was compared with the diagnosis at hospital admittance through the emergency room and classified as similar or discrepant according to a predefined scheme by two independent expert raters. Generalized linear mixed-effects models were used to estimate the effect of diagnostic discrepancy on mortality and length of hospital stay and to determine whether characteristics of patients, diagnosing physicians, and context predicted diagnostic discrepancy. RESULTS 755 consecutive patients (322 [42.7%] female; mean age 65.14 years) were included. The discharge diagnosis differed substantially from the admittance diagnosis in 12.3% of cases. Diagnostic discrepancy was associated with a longer hospital stay (mean 10.29 vs. 6.90 days; Cohen's d 0.47; 95% confidence interval 0.26 to 0.70; P = 0.002) and increased patient mortality (8 (8.60%) vs. 25(3.78%); OR 2.40; 95% CI 1.05 to 5.5 P = 0.038). A factor available at admittance that predicted diagnostic discrepancy was the diagnosing physician's assessment that the patient presented atypically for the diagnosis assigned (OR 3.04; 95% CI 1.33-6.96; P = 0.009). CONCLUSIONS Diagnostic discrepancies are a relevant healthcare problem in patients admitted through the emergency room because they occur in every ninth patient and are associated with increased in-hospital mortality. Discrepancies are not readily predictable by fixed patient or physician characteristics; attention should focus on context. TRIAL REGISTRATION https://bmjopen.bmj.com/content/6/5/e011585.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Hautz, Wolf; Sauter, Thomas; Exadaktylos, Aristomenis; Birrenbach, Tanja Nicole and Müller, Martin


600 Technology > 610 Medicine & health




BioMed Central




Christine Baumgartner

Date Deposited:

16 Jul 2019 17:16

Last Modified:

22 Oct 2019 18:25

Publisher DOI:


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