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

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 ca...

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Autores principales: Zhang, Dangui, Yan, Baoxin, He, Siqi, Tong, Shuangshuang, Huang, Peiling, Zhang, Qianjun, Cao, Yixun, Ding, Zhiheng, Ba-Thein, William
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10105461/
https://www.ncbi.nlm.nih.gov/pubmed/37059972
http://dx.doi.org/10.1186/s12887-023-03995-2
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author Zhang, Dangui
Yan, Baoxin
He, Siqi
Tong, Shuangshuang
Huang, Peiling
Zhang, Qianjun
Cao, Yixun
Ding, Zhiheng
Ba-Thein, William
author_facet Zhang, Dangui
Yan, Baoxin
He, Siqi
Tong, Shuangshuang
Huang, Peiling
Zhang, Qianjun
Cao, Yixun
Ding, Zhiheng
Ba-Thein, William
author_sort Zhang, Dangui
collection PubMed
description 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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spelling pubmed-101054612023-04-16 Diagnostic consistency between admission and discharge of pediatric cases in a tertiary teaching hospital in China Zhang, Dangui Yan, Baoxin He, Siqi Tong, Shuangshuang Huang, Peiling Zhang, Qianjun Cao, Yixun Ding, Zhiheng Ba-Thein, William BMC Pediatr Research 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. BioMed Central 2023-04-15 /pmc/articles/PMC10105461/ /pubmed/37059972 http://dx.doi.org/10.1186/s12887-023-03995-2 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/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/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://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.
spellingShingle Research
Zhang, Dangui
Yan, Baoxin
He, Siqi
Tong, Shuangshuang
Huang, Peiling
Zhang, Qianjun
Cao, Yixun
Ding, Zhiheng
Ba-Thein, William
Diagnostic consistency between admission and discharge of pediatric cases in a tertiary teaching hospital in China
title Diagnostic consistency between admission and discharge of pediatric cases in a tertiary teaching hospital in China
title_full Diagnostic consistency between admission and discharge of pediatric cases in a tertiary teaching hospital in China
title_fullStr Diagnostic consistency between admission and discharge of pediatric cases in a tertiary teaching hospital in China
title_full_unstemmed Diagnostic consistency between admission and discharge of pediatric cases in a tertiary teaching hospital in China
title_short Diagnostic consistency between admission and discharge of pediatric cases in a tertiary teaching hospital in China
title_sort diagnostic consistency between admission and discharge of pediatric cases in a tertiary teaching hospital in china
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10105461/
https://www.ncbi.nlm.nih.gov/pubmed/37059972
http://dx.doi.org/10.1186/s12887-023-03995-2
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