TY - JOUR
T1 - Antecedent treat-and-release diagnoses prior to sepsis hospitalization among adult emergency department patients
T2 - A look-back analysis employing insurance claims data using symptom-disease pair analysis of diagnostic error (spade) methodology
AU - Nassery, Najlla
AU - Horberg, Michael A.
AU - Rubenstein, Kevin B.
AU - Certa, Julia M.
AU - Watson, Eric
AU - Somasundaram, Brinda
AU - Shamim, Ejaz
AU - Townsend, Jennifer L.
AU - Galiatsatos, Panagis
AU - Pitts, Samantha I.
AU - Hassoon, Ahmed
AU - Newman-Toker, David E.
N1 - Funding Information:
Johns Hopkins University with funds provided by Grant No. #GBMF5756
Publisher Copyright:
© 2021 Walter de Gruyter GmbH, Berlin/Boston.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Objectives: The aim of this study was to identify delays in early pre-sepsis diagnosis in emergency departments (ED) using the Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) approach. Methods: SPADE methodology was employed using electronic health record and claims data from Kaiser Permanente Mid-Atlantic States (KPMAS). Study cohort included KPMAS members ≥18 years with ≥1 sepsis hospitalization 1/1/2013-12/31/2018. A look-back analysis identified treat-and-release ED visits in the month prior to sepsis hospitalizations. Top 20 diagnoses associated with these ED visits were identified; two diagnosis categories were distinguished as being linked to downstream sepsis hospitalizations. Observed-to-expected (O:E) and temporal analyses were performed to validate the symptom selection; results were contrasted to a comparison group. Demographics of patients that did and did not experience sepsis misdiagnosis were compared. Results: There were 3,468 sepsis hospitalizations during the study period and 766 treat-and-release ED visits in the month prior to hospitalization. Patients discharged from the ED with fluid and electrolyte disorders (FED) and altered mental status (AMS) were most likely to have downstream sepsis hospitalizations (O:E ratios of 2.66 and 2.82, respectively). Temporal analyses revealed that these symptoms were overrepresented and temporally clustered close to the hospitalization date. Approximately 2% of sepsis hospitalizations were associated with prior FED or AMS ED visits. Conclusions: Treat-and-release ED encounters for FED and AMS may represent harbingers for downstream sepsis hospitalizations. The SPADE approach can be used to develop performance measures that identify pre-sepsis.
AB - Objectives: The aim of this study was to identify delays in early pre-sepsis diagnosis in emergency departments (ED) using the Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) approach. Methods: SPADE methodology was employed using electronic health record and claims data from Kaiser Permanente Mid-Atlantic States (KPMAS). Study cohort included KPMAS members ≥18 years with ≥1 sepsis hospitalization 1/1/2013-12/31/2018. A look-back analysis identified treat-and-release ED visits in the month prior to sepsis hospitalizations. Top 20 diagnoses associated with these ED visits were identified; two diagnosis categories were distinguished as being linked to downstream sepsis hospitalizations. Observed-to-expected (O:E) and temporal analyses were performed to validate the symptom selection; results were contrasted to a comparison group. Demographics of patients that did and did not experience sepsis misdiagnosis were compared. Results: There were 3,468 sepsis hospitalizations during the study period and 766 treat-and-release ED visits in the month prior to hospitalization. Patients discharged from the ED with fluid and electrolyte disorders (FED) and altered mental status (AMS) were most likely to have downstream sepsis hospitalizations (O:E ratios of 2.66 and 2.82, respectively). Temporal analyses revealed that these symptoms were overrepresented and temporally clustered close to the hospitalization date. Approximately 2% of sepsis hospitalizations were associated with prior FED or AMS ED visits. Conclusions: Treat-and-release ED encounters for FED and AMS may represent harbingers for downstream sepsis hospitalizations. The SPADE approach can be used to develop performance measures that identify pre-sepsis.
KW - Delirium
KW - Diagnostic error
KW - Emergency medical services
KW - Health services research
KW - Sepsis
KW - Water-electrolyte balance
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U2 - 10.1515/dx-2020-0140
DO - 10.1515/dx-2020-0140
M3 - Article
C2 - 33650389
AN - SCOPUS:85119943457
SN - 2194-8011
VL - 8
SP - 469
EP - 478
JO - Diagnosis
JF - Diagnosis
IS - 4
ER -