Diagnostic consistency between admission and discharge of pediatric cases in a tertiary teaching hospital in China

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Abstract

Background

Patient-centered, high-quality health care relies on accurate and timely diagnosis. Diagnosis is a complex, error-prone process. Prevention of errors involves understanding the cause of errors. This study investigated diagnostic discordance between admission and discharge in pediatric cases.

Methods

We retrospectively reviewed the electronic medical records of 5381 pediatric inpatients during 2017–2018 in a tertiary teaching hospital. We analyzed diagnostic consistency by comparing the first 4 digits of admission and discharge ICD-10 codes of the cases and classified them as concordant for “complete and partial match” or discordant for “no match”.

Results

Diagnostic discordance was observed in 49.2% with the highest prevalence in infections of the nervous and respiratory systems ( Ps < 0.001). Multiple (multivariable) logistic regression analysis predicted a lower risk of diagnostic discordance with older children (aOR, 95%CI: 0.94, 0.93–0.96) and a higher risk with infectious diseases (aOR, 95%CI: 1.49, 1.33–1.66) and admission by resident and attending pediatricians (aOR, 95%CI: 1.41, 1.30–1.54). Discordant cases had a higher rate of antibiotic prescription (OR, 95%CI: 2.09, 1.87–2.33), a longer duration of antibiotic use ( P = 0.02), a longer length of hospital stay ( P < 0.001), and higher medical expenses ( P < 0.001).

Conclusions

This study denotes a considerably high rate of discordance between admission and discharge diagnoses with an associated higher and longer prescription of antibiotics, a longer length of stay, and higher medical expenses among Chinese pediatric inpatient cases. Infectious diseases were identified as high-risk clinical conditions for discordance. Considering potential diagnostic and coding errors, departmental investigation of preventable diagnostic discordance is suggested for quality health care and preventing potential medicolegal consequences.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-023-03995-2.

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Most cited references 19

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Microbiological Diagnostic Performance of Metagenomic Next-generation Sequencing When Applied to Clinical Practice

Qing Miao, Yuyan Ma, Qingqing Wang … (2018)

Metagenomic next-generation sequencing (mNGS) was suggested to potentially replace traditional microbiological methodology because of its comprehensiveness. However, clinical experience with application of the test is relatively limited.

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Measuring diagnoses: ICD code accuracy.

Kimberly O'Malley, Karon Cook, Matt D Price … (2005)

To examine potential sources of errors at each step of the described inpatient International Classification of Diseases (ICD) coding process. The use of disease codes from the ICD has expanded from classifying morbidity and mortality information for statistical purposes to diverse sets of applications in research, health care policy, and health care finance. By describing a brief history of ICD coding, detailing the process for assigning codes, identifying where errors can be introduced into the process, and reviewing methods for examining code accuracy, we help code users more systematically evaluate code accuracy for their particular applications. We summarize the inpatient ICD diagnostic coding process from patient admission to diagnostic code assignment. We examine potential sources of errors at each step and offer code users a tool for systematically evaluating code accuracy. Main error sources along the "patient trajectory" include amount and quality of information at admission, communication among patients and providers, the clinician's knowledge and experience with the illness, and the clinician's attention to detail. Main error sources along the "paper trail" include variance in the electronic and written records, coder training and experience, facility quality-control efforts, and unintentional and intentional coder errors, such as misspecification, unbundling, and upcoding. By clearly specifying the code assignment process and heightening their awareness of potential error sources, code users can better evaluate the applicability and limitations of codes for their particular situations. ICD codes can then be used in the most appropriate ways.

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Is Open Access

The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations

Hardeep Singh, Ashley Meyer, Eric Thomas (2014)

Background The frequency of outpatient diagnostic errors is challenging to determine due to varying error definitions and the need to review data across multiple providers and care settings over time. We estimated the frequency of diagnostic errors in the US adult population by synthesising data from three previous studies of clinic-based populations that used conceptually similar definitions of diagnostic error. Methods Data sources included two previous studies that used electronic triggers, or algorithms, to detect unusual patterns of return visits after an initial primary care visit or lack of follow-up of abnormal clinical findings related to colorectal cancer, both suggestive of diagnostic errors. A third study examined consecutive cases of lung cancer. In all three studies, diagnostic errors were confirmed through chart review and defined as missed opportunities to make a timely or correct diagnosis based on available evidence. We extrapolated the frequency of diagnostic error obtained from our studies to the US adult population, using the primary care study to estimate rates of diagnostic error for acute conditions (and exacerbations of existing conditions) and the two cancer studies to conservatively estimate rates of missed diagnosis of colorectal and lung cancer (as proxies for other serious chronic conditions). Results Combining estimates from the three studies yielded a rate of outpatient diagnostic errors of 5.08%, or approximately 12 million US adults every year. Based upon previous work, we estimate that about half of these errors could potentially be harmful. Conclusions Our population-based estimate suggests that diagnostic errors affect at least 1 in 20 US adults. This foundational evidence should encourage policymakers, healthcare organisations and researchers to start measuring and reducing diagnostic errors.

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Author and article information

Contributors

William Ba-Thein: wbathein@stu.edu.cn , williambathein@gmail.com

Journal

Journal ID (nlm-ta): BMC Pediatr

Journal ID (iso-abbrev): BMC Pediatr

Title: BMC Pediatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2431

Publication date (Electronic): 15 April 2023

Publication date PMC-release: 15 April 2023

Publication date Collection: 2023

Volume: 23

Electronic Location Identifier: 176

Affiliations

[1 ]GRID grid.452836.e, ISNI 0000 0004 1798 1271, Research Center of Translational Medicine, , Second Affiliated Hospital of Shantou University Medical College, ; Shantou, P. R. China

[2 ]GRID grid.411679.c, ISNI 0000 0004 0605 3373, Undergraduate Research Training Program (UGRTP), , Shantou University Medical College, ; Shantou, P. R. China

[3 ]GRID grid.411679.c, ISNI 0000 0004 0605 3373, Clinical Research Unit, , Shantou University Medical College, ; Shantou, P. R. China

[4 ]GRID grid.411679.c, ISNI 0000 0004 0605 3373, Department of Microbiology and Immunology, , Shantou University Medical College, ; Shantou, P. R. China

[5 ]GRID grid.411679.c, ISNI 0000 0004 0605 3373, Clinical Research Unit and Dept. of Microbiology and Immunology, , Shantou University Medical College, ; 11/F, Science & Technology Building, 22 Xinling Road, Shantou, 515041 Guangdong P. R. China

Article

Publisher ID: 3995

DOI: 10.1186/s12887-023-03995-2

PMC ID: 10105461

PubMed ID: 37059972

SO-VID: c63a5cdb-d2fc-48d1-8891-675be783be8a

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 13 September 2022

Date accepted : 6 April 2023

Funding

Funded by: Undergraduate Research Training Program (UGRTP)

Award ID: LE0003

Custom metadata

ScienceOpen disciplines: Pediatrics

Keywords: icd-10,discrepancy,discordance,coding error,diagnostic error,pediatric,china

Data availability:

ScienceOpen disciplines: Pediatrics

Keywords: icd-10, discrepancy, discordance, coding error, diagnostic error, pediatric, china

Diagnostic consistency between admission and discharge of pediatric cases in a tertiary teaching hospital in China

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Abstract

Background

Methods

Results

Conclusions

Supplementary Information

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Pediatric Pulse: Advancing Neonatal and Child Health

Most cited references 19

Microbiological Diagnostic Performance of Metagenomic Next-generation Sequencing When Applied to Clinical Practice

Measuring diagnoses: ICD code accuracy.

The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations

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