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Analysis of Variation Between Diagnosis at Admission vs Discharge and Clinical Outcomes Among Adults With Possible Bacteremia.
Dregmans, Emma; Kaal, Anna G; Meziyerh, Soufian; Kolfschoten, Nikki E; van Aken, Maarten O; Schippers, Emile F; Steyerberg, Ewout W; van Nieuwkoop, Cees.
Afiliação
  • Dregmans E; Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands.
  • Kaal AG; Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands.
  • Meziyerh S; Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands.
  • Kolfschoten NE; Department of Emergency Medicine, Haga Teaching Hospital, The Hague, the Netherlands.
  • van Aken MO; Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands.
  • Schippers EF; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
  • Steyerberg EW; Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands.
  • van Nieuwkoop C; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
JAMA Netw Open ; 5(6): e2218172, 2022 06 01.
Article em En | MEDLINE | ID: mdl-35737389
ABSTRACT
Importance Misdiagnosis of infection is among the most commonly made diagnostic errors and is associated with increased morbidity and mortality. Little is known about how often misdiagnosed site of infection occurs and its association with clinical outcomes.

Objectives:

To evaluate the discrepancy between admission and discharge site of infection diagnoses among patients with suspected bacteremia, to explore factors associated with discrepant diagnoses, and to evaluate the association with clinical outcomes. Design, Setting, and

Participants:

This cohort study used electronic records of 1477 adult patients who were admitted to the hospital for suspected bacteremia from April 1, 2019, to May 31, 2020, and who had blood cultures taken at the emergency department at Haga Teaching Hospital, The Hague, the Netherlands. Suspected infection sites were classified into 8 categories at admission and discharge. Misdiagnosed site was defined as a discrepancy between the suspected site of infection at admission and at discharge. Main Outcomes and

Measures:

Clinical outcomes were 30-day mortality, intensive care unit admission, length of hospital stay, and antibiotic use, analyzed with logistic and linear regression. Risk factors for misdiagnosed site were determined using regression analysis.

Results:

A total of 1477 patients (820 [55.5%] male; median [IQR] age, 68 [56-78] years) were analyzed. The rate of misdiagnosed site of infection was 11.6% (171 of 1477); 3.1% of all patients (46 of 1477) ultimately had no infection. No association was found between misdiagnosis and 30-day mortality (adjusted odds ratio [aOR], 0.8; 95% CI, 0.3-1.9; P = .60), intensive care unit admission (aOR, 1.3; 95% CI, 0.6-3.0; P = .54), and hospital length of stay (adjusted increase of stay, 15.5%; 95% CI, -3.1% to 37.7%; P = .11). Misdiagnosed site was associated with receiving broad-spectrum antibiotics (aOR, 4.0; 95% CI, 1.8-8.8; P < .001). Older age, dementia, a positive urine sediment test result without urinary symptoms, and suspicion of an intravascular, central nervous system, or bone and joint infection were risk factors for misdiagnosed site of infection. Conclusions and Relevance In this cohort study, misdiagnosed site of infection occurred in 1 of 9 patients and was not associated with worse short-term clinical outcomes. Clinicians should be aware of risk factors associated with misdiagnosed site of infection and potential inappropriate antibiotic use.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Alta do Paciente / Bacteriemia Tipo de estudo: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Alta do Paciente / Bacteriemia Tipo de estudo: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male Idioma: En Ano de publicação: 2022 Tipo de documento: Article