Discrepancy between admission diagnosis in emergency and final diagnosis in ward and its correlation with length of hospital stay and mortality

Abstract

Background: Inception of emergency medicine as a specialty in India is on a rise. Data on the accuracy of diagnosis made in emergency rooms in India is scarce and with varied results with especially no such data available from our part of the country. Aim: The aim of this study was to evaluate the discrepancy between admission diagnosis in emergency and final diagnosis in ward and its correlation with length of hospital stay and outcome. This study was an observational prospective study. Materials and Methods: Patients were categorised as per the International Classification of Diseases – Version 10. A total of 2000 patients were enrolled in the study. The patients were followed from admission to discharge. Data were categorised into two major groups – 'Concordant' diagnosis and 'Discordant' diagnosis. Univariate analysis was performed using SPSS version 20.0. Results: Five hundred and fifty-three (27.65%) patients had a final diagnosis in ward discordant from the initial diagnosis in the medical emergency room. The frequency of discrepancy was highest for the genitourinary system (39%) and relatively low for neoplasm (16%). The average length of hospital stay in the concordant group of patients was 5.15 days, whereas it was 7.05 days in the discordant group (P = 0.003). There was a statistically significant increase in percentage mortality in patients when initial and final diagnoses did not match (P = 0.0005). Conclusions: A diagnostic discrepancy of 27.65% occurred between admission diagnosis in the medical emergency room and final diagnosis in ward. The diagnostic discrepancy resulted in a significant increase in the length of hospital stay and mortality.