Misdiagnosis is a major public health problem, causing increased morbidity and mortality. In the busy setting of an emergency department (ED) patients are diagnosed under difficult circumstances. As a consequence, the ED diagnosis at hospital admittance may often be a descriptive diagnosis, such as “decreased general condition”. Our objective was to determine in how far patients with such an unspecific ED diagnosis differ from patients with a specific ED diagnosis and whether they experience a worse outcome. We conducted a prospective observational study in Bern university hospital in Switzerland for all adult non-trauma patients admitted to any internal medicine ward from August 15th 2015 to December 7th 2015. Unspecific ED diagnoses were defined through the clinical classification software for ICD-10 by two outcome assessors. As outcome parameters, we assessed in-hospital mortality and length of hospital stay. Six hundred eighty six consecutive patients were included. Unspecific diagnoses were identified in 100 (14.6%) of all consultations. Patients receiving an unspecific diagnosis at ED discharge were significantly more often women (56.0% vs. 43.9%, p = 0.024), presented more often with a non-specific complaint (34% vs. 21%, p = 0.004), were less often demonstrating an abnormal heart rate (5.0% vs. 12.5%, p = 0.03), and less often on antibiotics (32.0% vs. 49.0%, p = 0.002). Apart from these, no studied drug intake, laboratory or clinical data including change in diagnosis was associated significantly with an unspecific diagnosis. Unspecific diagnoses were neither associated with in-hospital mortality in multivariable analysis (OR = 1.74, 95% CI: 0.60–5.04; p = 0.305) adjusted for relevant confounders nor with length of hospital stay (GMR = 0.87, 95% CI: 0.23–3.32; p = 0.840). Women and patients with non-specific presenting complaints and no abnormal heart rate are at risk of receiving unspecific ED diagnoses that do not allow for targeted treatment, discharge and prognosis. This study did not find an effect of such diagnoses on length of hospital stay nor in-hospital mortality.

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急诊科非特异性医学诊断的频率和预测因素：一项前瞻性观察研究

误诊是一个重大的公共卫生问题，导致发病率和死亡率增加。在急诊科 (ED) 的繁忙环境中，患者在困难的情况下被诊断出来。因此，入院时的 ED 诊断通常可能是描述性诊断，例如“一般情况下降”。我们的目标是确定具有这种非特异性 ED 诊断的患者与具有特定 ED 诊断的患者的差异有多大，以及他们是否经历更差的结果。我们在瑞士伯尔尼大学医院对 2015 年 8 月 15 日至 2015 年 12 月 7 日期间入住任何内科病房的所有成人非创伤患者进行了一项前瞻性观察研究。通过 ICD-10 的临床分类软件定义了两个非特异性 ED 诊断。结果评估员。作为结果参数，我们评估了住院死亡率和住院时间。包括 686 名连续患者。在所有会诊中，有 100 人（14.6%）被确定为非特异性诊断。在 ED 出院时接受非特异性诊断的患者明显更多是女性（56.0% 对 43.9%，p = 0.024），更多出现非特异性主诉（34% 对 21%，p = 0.004），更少经常表现出心率异常（5.0% 对 12.5%，p = 0.03），并且较少使用抗生素（32.0% 对 49.0%，p = 0.002）。除此之外，没有研究的药物摄入量、实验室或临床数据（包括诊断变化）与非特异性诊断显着相关。在多变量分析中，非特异性诊断与住院死亡率均无关（OR = 1.74，95% CI：0.60-5.04；p = 0。305）针对相关混杂因素和住院时间进行了调整（GMR = 0.87，95% CI：0.23–3.32；p = 0.840）。有非特异性主诉和无异常心率的女性和患者有接受非特异性 ED 诊断的风险，这些诊断不允许有针对性的治疗、出院和预后。该研究未发现此类诊断对住院时间或住院死亡率的影响。