Diagnostic Change

Diagnostic change of ICD10 diagnose from the ED to hospital discharge

Title

Is patient outcome associated with change of ICD10 diagnose from the ED to hospital discharge?

Aim

To investigate the association between diagnostic concordance of dyspneic ED patients and the length of inpatient-unit stay, readmission, and mortality.

Methods

This cohort study included all ED contacts that were triaged with a dyspneic chief complaint and admitted to an inpatient unit at Aarhus University Hospital. from July 1, 2016 to June 30, 2017. Patients with an ED-diagnosis from the R or Z ICD10-chapters (“Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified” and “Factors influencing health status and contact with health services“) were excluded from the analyses. Data sources included the electronic medical patient records, clinical biochemistry and radiological data, and the Danish Civil Registration System. Exposure-groups, diagnostic concordance and disconcordance, were based on difference between ED-diagnosis and the final discharge-diagnosis. All diagnoses were grouped in a pre-defined ICD10-diagnosis categorization that group clinically similar “three-character categories ”. Outcomes were length of inpatient-unit stay, incidence proportions for 7- and 30-day readmission and 30-day mortality. A multiple linear regression model was applied to compute crude and adjusted absolute and relative difference of continuous outcomes; and a logistic regression model was used for odds ratio computations of binary outcomes. Finally, two secondary sub-analyses, repeating the primary analyses, were conducted: 1) foc using patients in the top 10 diagnosis-categories (ED-diagnoses), and 2) redefining exposure-groups by using the ICD10 “blocks of categories” categorization.

Perspective

This study contribute to the understanding of the high mortality of ED patients with dyspnea as cheif complaint.

Conflicts of Interest

None

Collaborators

Emergency Department, Aarhus University Hospital 

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