In-hospital mortality associated with the misdiagnosis or unidentified site of infection at admission
Year: 2019
Type: article
Abstract: BACKGROUND: Rapid detection, early resuscitation, and appropriate antibiotic use are crucial for sepsis care. Accurate identification of the site of infection may facilitate a timely provision of appropriate care. We aimed to investigate the relationship between misdiagnosis of the site of infection at initial examination and in-hospital mortality. METHODS: This was a secondary-multicenter prospective cohort study involving 37 emergency departments. Consecutive adult patients with infection from December 2017 to February 2018 were included. Misdiagnosis of the site of infection was defined as a discrepancy between the suspected site of infection at initial examination and that at final diagnosis, including those infections remaining unidentified during hospital admission, whereas correct diagnosis was defined as site concordance. In-hospital mortality was compared between those misdiagnosed and those correctly diagnosed. RESULTS: Of 974 patients included in the analysis, 11.6% were misdiagnosed. Patients diagnosed with lung, intra-abdominal, urinary, soft tissue, and CNS infection at the initial examination, 4.2%, 3.8%, 13.6%, 10.9%, and 58.3% respectively, turned out to have an infection at a different site. In-hospital mortality occurred in 15%. In both generalized estimating equation (GEE) and propensity score-matched models, misdiagnosed patients exhibited higher mortality despite adjustment for patient background, site infection, and severity. The adjusted odds ratios (misdiagnosis vs. correct diagnosis) for in-hospital mortality were 2.66 (95% CI, 1.45-4.89) in the GEE model and 3.03 (95% CI, 1.24-7.38) in the propensity score-matched model. The difference in the absolute risk in the GEE model was 0.11 (0.04-0.18). CONCLUSIONS: Among patients with infection, misdiagnosed site of infection is associated with a > 10% increase in in-hospital mortality.
Source: Critical Care
Authors: for the JAAM SPICE Study Group, Toshikazu Abe, Yasuharu Tokuda, Atsushi Shiraishi, Seitaro Fujishima, Toshihiko Mayumi, Takehiro Sugiyama, Gautam A. Deshpande, Yasukazu Shiino, Toru Hifumi, Yasuhiro Otomo, Kohji Okamoto, Joji Kotani, Yuichiro Sakamoto, Junichi Sasaki, Shin-ichiro Shiraishi, Kiyotsugu Takuma, Akiyoshi Hagiwara, Kazuma Yamakawa, Naoshi Takeyama, Satoshi Gando
Institutions: Juntendo University, University of Tsukuba, Okinawa Prefecture, Research and Development Center for Health Services, University of Tsukuba, Kameda Medical Center, Keio University, University of Occupational and Environmental Health Japan, National Center for Global Health and Medicine, The University of Tokyo, Kawasaki Medical School, St. Luke's International Hospital, Tokyo Medical and Dental University, Kitakyushu City Hospital Organization, Kitakyushu City Yahata Hospital, Kobe University, Saga University, Keio University Hospital, Aidu Chuo Hospital, Kawasaki Municipal Hospital, Osaka Prefectural Medical Center, Aichi Medical University, Aichi Medical University Hospital, Hokkaido University, Sapporo Higashi Tokushukai Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,890
Funders: National Center for Global Health and Medicine, University of Occupational and Environmental Health, Keio University, Fukuoka University, Hokkaido University, Tokyo Medical and Dental University, Kawasaki Medical School, Tokyo Women's Medical University, Kansai Medical University, Japan Society for the Promotion of Science
OpenAlex ID: W2948132003