[Diagnosis mistake in the emergency room: relation to main symptom at admission, reasons and clinical implications].
OBJECTIVE
We intended to analyze the relation between the main symptom at hospital admission and the diagnosis mistake, assessing the reasons and clinical implications.


METHODS
We analyzed hospitalized patients from the emergency room to the medical wards. We collected: age, sex, time, main symptom at admission, diagnosis at admission and final diagnosis, days of hospitalization and mortality. We established two groups: patients with a concordant diagnosis and patients with a wrong diagnosis, and we compared the characteristics of them. In each case of a wrong diagnosis, we analyzed the reason of the mistake and the clinical consequences.


RESULTS
We found a wrong diagnosis in 42 (6.2%) cases. Fever, as main symptom at admission, had a significant higher rate of mistake than other symptoms. No differences were found in the other variables analyzed. Most frequently omitted diagnosis were infectious diseases, pulmonary embolism and heart failure. Main causes of mistake were a deficient clinical evaluation and X-ray interpretation. The mistake implied a delay in the specific treatment in 42.8% cases.


CONCLUSIONS
Diagnostic mistakes in the emergency room are more frequent in patients attending with fever. They are mostly related to deficient clinical evaluation or wrong interpretation of X-ray findings. Although these mistakes usually lead to a delay in the treatment, no increase in the days of hospitalization or mortality is observed.
Tudela
Pere
P
Unidad de Urgencias, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. pth@ns.hugtip.scs.es
Mòdol
Josep María
JM
Rego
María José
MJ
Bonet
Montserrat
M
Vilaseca
Blanca
B
Tor
Jordi
J
D000368:Aged; D003951:Diagnostic Errors; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged