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首页> 外文期刊>Sao Paulo Medical Journal >Diagnostic discrepancies between emergency department admissions and hospital discharges among older adults: secondary analysis on a population-based survey
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Diagnostic discrepancies between emergency department admissions and hospital discharges among older adults: secondary analysis on a population-based survey

机译：高等成年人急诊招生与医院院票诊断差异：基于人口调查的二级分析

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BACKGROUND: Older adults frequently experience nonspecific clinical features. However, there is limited evidence on how often admission diagnoses for hospitalized older patients are incorrect, potentially leading to treatment delays. OBJECTIVES: To determine the consistency between hospital admission and discharge diagnoses, and identify factors associated with diagnostic discrepancies in older adults. DESIGN AND SETTING: Population-based cohort study in the United States. We included adults aged ≥ 18 years who were admitted from emergency departments (EDs) to hospitals, identified using the 2005-2010 National Hospital Ambulatory Medical Survey, a nationally representative survey. METHODS: Three admission diagnoses and the principal discharge diagnosis were captured and classified as discrepant if they involved considerably different conditions within the same organ system, or different organ systems altogether. RESULTS: Each year, 12 million adults were hospitalized following ED visits in the United States; 45% were aged ≥ 65 years. These patients' mean age was 79 years and 58% were women. Diagnostic discrepancies between admission and discharge were more common among adults ≥ 65 years (12.5 versus 8.3%; P 0.001). Certain admission diagnoses had particularly high rates of diagnostic discrepancies: 26-27% of patients presenting with mental disorders or with endocrine and metabolic diseases had substantial diagnostic discrepancies between admission and discharge. Substantial diagnostic discrepancy was independently associated with longer hospitalization and higher in-hospital mortality. CONCLUSION: One out of eight older adults hospitalized from EDs was discharged with a principal diagnosis differing considerably from the admission diagnosis. Given that missed or delayed diagnoses are a critical safety problem, clinicians should be vigilant and frequently cogitate alternative diagnostic possibilities.
机译：背景：老年人经常经历非特异性的临床特征。但是，有关入住老年患者的入院诊断的频率如何不正确，可能导致治疗延迟有限。目标：确定医院入院和票据诊断之间的一致性，并确定与老年人诊断差异相关的因素。设计与环境：美国人口的队列研究。我们包括年龄≥18岁的成年人，他到医院的急诊部门（EDS），使用2005-2010全国医院守护医学调查确定，该调查显示。方法：如果涉及相同的器官系统内的不同条件，或者完全不同的器官系统，则捕获三个入学诊断和主要放电诊断并归类为差异。结果：每年120万成年人在美国访问次数后住院; 45％≥65岁。这些患者的平均年龄为79岁，58％是女性。入场和排放之间的诊断差异在成人≥65岁之间更常见（12.5与8.3％; P <0.001）。某些入学诊断特别高的诊断差异率：26-27％的患者患有精神障碍或内分泌和新代谢疾病在入学和出院之间具有大量诊断差异。实质性诊断差异与较长的住院和较高的住院死亡率有关。结论：从EDS住院住院的8名老年人中有一项，主要诊断与入院诊断相当不同。鉴于错过或延迟诊断是一个关键的安全问题，临床医生应保持警惕，经常敏捷替代诊断可能性。

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