Diagnosis of pneumonia in the ED has poor accuracy despite diagnostic uncertainty

Rishi Sikka, Laura H. Tommaso, Carleen Kaucky, Erik B. Kulstad

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: In 2007, the Centers for Medicare and Medicaid Services created a measure known as diagnostic uncertainty in emergency department (ED) pneumonia admissions. This documentation excludes the antibiotic timing measure, as pressure to quickly diagnose pneumonia may serve to reduce overall accuracy. Study objectives: The objective of the study was to determine the correlation between ED and final discharge diagnosis of pneumonia and measure the effect of invoking the diagnostic uncertainty documentation on accuracy. Methods: We retrospectively reviewed all ED pneumonia admissions among adults from July to October 2008. We analyzed the effect of invoking the diagnostic uncertainty documentation in the ED by comparing against final outcomes. We then performed a multivariate analysis to adjust for the potential effects of sex, age, Emergency Severity Index (ESI) score, weekend arrival, and level of ED-attending physician staffing. Results: Of 401 patients who were admitted with pneumonia, 297 (74%) had a discharge diagnosis of pneumonia, with 72 (18%) of those diagnoses being the primary outcome. Diagnostic uncertainty documentation was used in 11% (45/401). This documentation did not significantly alter the odds of a primary pneumonia discharge diagnosis (odds ratio, 0.68; 95% confidence interval, 0.28-1.7) but did reduce the odds of pneumonia being diagnosed (odds ratio, 0.43; 95% confidence interval, 0.23-0.81). Sex, age, day of week, and (ESI) score remained nonsignificant predictors. Conclusions: Correlation between ED and discharge diagnosis of pneumonia was limited. Use of diagnostic uncertainty documentation decreased the likelihood of a hospital discharge diagnosis of pneumonia. Further analysis of the effects of artificially imposed time constraints on ED diagnoses appears warranted.

Original languageEnglish (US)
Pages (from-to)881-885
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume30
Issue number6
DOIs
StatePublished - Jul 1 2012

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Uncertainty
Hospital Emergency Service
Pneumonia
Documentation
Emergencies
Odds Ratio
Confidence Intervals
Centers for Medicare and Medicaid Services (U.S.)
Multivariate Analysis
Anti-Bacterial Agents
Physicians
Pressure

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Diagnosis of pneumonia in the ED has poor accuracy despite diagnostic uncertainty. / Sikka, Rishi; Tommaso, Laura H.; Kaucky, Carleen; Kulstad, Erik B.

In: American Journal of Emergency Medicine, Vol. 30, No. 6, 01.07.2012, p. 881-885.

Research output: Contribution to journalArticle

Sikka, Rishi ; Tommaso, Laura H. ; Kaucky, Carleen ; Kulstad, Erik B. / Diagnosis of pneumonia in the ED has poor accuracy despite diagnostic uncertainty. In: American Journal of Emergency Medicine. 2012 ; Vol. 30, No. 6. pp. 881-885.
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abstract = "Background: In 2007, the Centers for Medicare and Medicaid Services created a measure known as diagnostic uncertainty in emergency department (ED) pneumonia admissions. This documentation excludes the antibiotic timing measure, as pressure to quickly diagnose pneumonia may serve to reduce overall accuracy. Study objectives: The objective of the study was to determine the correlation between ED and final discharge diagnosis of pneumonia and measure the effect of invoking the diagnostic uncertainty documentation on accuracy. Methods: We retrospectively reviewed all ED pneumonia admissions among adults from July to October 2008. We analyzed the effect of invoking the diagnostic uncertainty documentation in the ED by comparing against final outcomes. We then performed a multivariate analysis to adjust for the potential effects of sex, age, Emergency Severity Index (ESI) score, weekend arrival, and level of ED-attending physician staffing. Results: Of 401 patients who were admitted with pneumonia, 297 (74{\%}) had a discharge diagnosis of pneumonia, with 72 (18{\%}) of those diagnoses being the primary outcome. Diagnostic uncertainty documentation was used in 11{\%} (45/401). This documentation did not significantly alter the odds of a primary pneumonia discharge diagnosis (odds ratio, 0.68; 95{\%} confidence interval, 0.28-1.7) but did reduce the odds of pneumonia being diagnosed (odds ratio, 0.43; 95{\%} confidence interval, 0.23-0.81). Sex, age, day of week, and (ESI) score remained nonsignificant predictors. Conclusions: Correlation between ED and discharge diagnosis of pneumonia was limited. Use of diagnostic uncertainty documentation decreased the likelihood of a hospital discharge diagnosis of pneumonia. Further analysis of the effects of artificially imposed time constraints on ED diagnoses appears warranted.",
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AB - Background: In 2007, the Centers for Medicare and Medicaid Services created a measure known as diagnostic uncertainty in emergency department (ED) pneumonia admissions. This documentation excludes the antibiotic timing measure, as pressure to quickly diagnose pneumonia may serve to reduce overall accuracy. Study objectives: The objective of the study was to determine the correlation between ED and final discharge diagnosis of pneumonia and measure the effect of invoking the diagnostic uncertainty documentation on accuracy. Methods: We retrospectively reviewed all ED pneumonia admissions among adults from July to October 2008. We analyzed the effect of invoking the diagnostic uncertainty documentation in the ED by comparing against final outcomes. We then performed a multivariate analysis to adjust for the potential effects of sex, age, Emergency Severity Index (ESI) score, weekend arrival, and level of ED-attending physician staffing. Results: Of 401 patients who were admitted with pneumonia, 297 (74%) had a discharge diagnosis of pneumonia, with 72 (18%) of those diagnoses being the primary outcome. Diagnostic uncertainty documentation was used in 11% (45/401). This documentation did not significantly alter the odds of a primary pneumonia discharge diagnosis (odds ratio, 0.68; 95% confidence interval, 0.28-1.7) but did reduce the odds of pneumonia being diagnosed (odds ratio, 0.43; 95% confidence interval, 0.23-0.81). Sex, age, day of week, and (ESI) score remained nonsignificant predictors. Conclusions: Correlation between ED and discharge diagnosis of pneumonia was limited. Use of diagnostic uncertainty documentation decreased the likelihood of a hospital discharge diagnosis of pneumonia. Further analysis of the effects of artificially imposed time constraints on ED diagnoses appears warranted.

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