Missed Serious Neurologic Conditions in Emergency Department Patients Discharged With Nonspecific Diagnoses of Headache or Back Pain - 19/09/19
, Jonathan A. Edlow, MD a, Tadahiro Goto, MD, MPH b, Carlos A. Camargo, MD, DrPH b, Kohei Hasegawa, MD, MPH bAbstract |
Study objective |
Serious neurologic conditions can be missed on initial emergency department (ED) visit and discharge diagnosis oftentimes remains a nonspecific symptom. We aim to examine the incidence of potential harm from serious neurologic conditions in ED patients discharged with a nonspecific diagnosis of headache or back pain, identify specific missed conditions, and determine risk factors for potential misdiagnosis-related harm.
Methods |
This was a retrospective analysis using the population-based data of 6 US states from the State Emergency Department Databases and State Inpatient Databases from 2006 through 2012. We identified adults (≥18 years) discharged from the ED with a diagnosis of atraumatic headache or back pain. The primary outcome was a composite of return ED visit and hospitalization for primary diagnosis of a serious neurologic condition or inhospital death within 30 days of ED discharge.
Results |
There were 2,101,081 ED discharges with a nonspecific diagnosis of headache and 1,381,614 discharges with a nonspecific diagnosis of back pain. Overall, 0.5% of the headache patients and 0.2% of back pain patients had a primary outcome. The most common missed condition for headache was ischemic stroke (18.1%). The most common missed condition for back pain was intraspinal abscess (41%). In both populations, advanced age, male sex, non-Hispanic white, and comorbidities (eg, neurologic disorders, HIV/AIDS, malignancy) were associated with higher odds of outcome.
Conclusion |
A small proportion of ED patients discharged with nonspecific diagnoses of headache or back pain returned with a serious neurologic condition or inhospital death within 30 days.
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| Please see page 550 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Clifton Callaway, MD, PhD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: NMD, JAE, and KH conceived the study and designed the analysis. TG and CAC provided statistical advice on study design. TG analyzed the data. NMD drafted the article, and all authors contributed substantially to its revision. NMD takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. |
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Vol 74 - N° 4
P. 549-561 - octobre 2019 Retour au numéro
Article précédent
- The Reality of Pain Scoring in the Emergency Department: Findings From a Multiple Case Study Design
- Fiona C. Sampson, Steve W. Goodacre, Alicia O’Cathain
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- Bernard P. Chang, Sara Rostanski, Joshua Willey, Eliza C. Miller, Steven Shapiro, Rachel Mehendale, Benjamin Kummer, Babak B. Navi, Mitchell S.V. Elkind
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