Multicenter evaluation of a method to identify delayed diagnosis of diabetic ketoacidosis and sepsis in administrative data.
Diagnosis (Berl)
; 10(4): 383-389, 2023 Nov 01.
Article
en En
| MEDLINE
| ID: mdl-37340621
ABSTRACT
OBJECTIVES:
To derive a method of automated identification of delayed diagnosis of two serious pediatric conditions seen in the emergency department (ED) new-onset diabetic ketoacidosis (DKA) and sepsis.METHODS:
Patients under 21 years old from five pediatric EDs were included if they had two encounters within 7 days, the second resulting in a diagnosis of DKA or sepsis. The main outcome was delayed diagnosis based on detailed health record review using a validated rubric. Using logistic regression, we derived a decision rule evaluating the likelihood of delayed diagnosis using only characteristics available in administrative data. Test characteristics at a maximal accuracy threshold were determined.RESULTS:
Delayed diagnosis was present in 41/46 (89â¯%) of DKA patients seen twice within 7 days. Because of the high rate of delayed diagnosis, no characteristic we tested added predictive power beyond the presence of a revisit. For sepsis, 109/646 (17â¯%) of patients were deemed to have a delay in diagnosis. Fewer days between ED encounters was the most important characteristic associated with delayed diagnosis. In sepsis, our final model had a sensitivity for delayed diagnosis of 83.5â¯% (95â¯% confidence interval 75.2-89.9) and specificity of 61.3â¯% (95â¯% confidence interval 56.0-65.4).CONCLUSIONS:
Children with delayed diagnosis of DKA can be identified by having a revisit within 7 days. Many children with delayed diagnosis of sepsis may be identified using this approach with low specificity, indicating the need for manual case review.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Cetoacidosis Diabética
/
Sepsis
Tipo de estudio:
Diagnostic_studies
/
Guideline
/
Prognostic_studies
Límite:
Adolescent
/
Child
/
Humans
Idioma:
En
Revista:
Diagnosis (Berl)
Año:
2023
Tipo del documento:
Article
País de afiliación:
Estados Unidos