Predictors and Outcome of Diagnostic Error in Patients at Risk for Critical Illness
Chae J, Jayaprakash N, Sabov M, Samavedam S, Gajic O, and Pickering BW. Predictors and outcome of diagnostic error in patients at risk for critical illness. Am J Respir Crit Care Med 2018.
Am J Respir Crit Care Med
Introduction: Diagnostic error and delay are recognized factors that contribute to avoidable illness. The goal of this study was to validate a previously developed standard operating procedure (SOP) used to identify diagnostic error and delay, identify predictors and assess outcomes in adult patients at risk for critical illness.
Methods: This was a retrospective observational study at Mayo Clinic Rochester reviewing a convenience sample of adult patients admitted to the hospital in the year 2012 who had a rapid response team (RRT) call during their hospitalization. A previously developed standard operating procedure reliably identified diagnostic error or delay in a convenience sample. In this study we validated our findings by identifying predictors and assessing outcomes of mortality and hospital length of stay in those with and without diagnostic error or delay through multivariate logistic regression analysis.
Results: Our convenience sample included 130 patients that were selected for detailed review. Diagnostic error or delay was present in 23 patients. Hospital mortality for this group was 60%, compared to 19% in the group without diagnostic error or delay (p<0.001). Diagnostic error or delay was associated with a higher comorbidity burden, with a Charlson comorbidity index of 5 (IQR 2-7) vs 2 (IQR 0-5), p=0.018. When adjusted for baseline differences, diagnostic error or delay was associated with a markedly increased chance of dying, OR 5.7 (95 % CI 1.98 - 17.82).
Conclusion: Diagnostic error and delay occurs more often in patients with chronic comorbidities. Furthermore, diagnostic error and delay is independently associated with increased mortality.