Initial Versus Final Diagnosis in Patients Who Presented to the Emergency Department Without Trauma: A Prospective Cohort Study

Abstract

Aim:In the emergency department (ED), some patients are discharged after their initial diagnosis and treatment, whereas others are hospitalized for treatment and/or further diagnostic examination. The ED physician usually does not receive feedback regarding diagnostic accuracy, treatment effectiveness, or morbidity or mortality of the patient. In this study, patients in the ED without trauma were followed up to obtain their data.Materials and Methods:This prospective cohort study includes all patients without trauma who are admitted to the ED of a tertiary hospital during the two-month time frame and were hospitalized in various clinics. Data recorded for each patient are the following: demographic information, vital signs, diagnosis upon admission, diagnosis after hospitalization, length of stay, mortality, and complications.Results:A total of 740 patients that met the inclusion criteria participated in this study. The mean age was 54 years, wherein 398 patients (53.8%) were male. The initial diagnosis of 22 patients (2.9%) changed after further examinations. The mean age of these patients were 42 years, and 11 patients were male (50%). Emergency invasive intervention was significantly more common among patients with changed diagnosis (cDx) (40.9% vs 4.1%, p<0.001). Consequently, the incidence of complications was higher in cDx patients (31.8% vs 10.8%, p=0.01).Conclusion:Majority of patients hospitalized from the ED were treated according to their initial diagnosis until the initial department of hospitalization. We conclude that ED functions at an adequate accuracy despite their high workload.

Keywords

• emergency department
• hospitalization
• non-traumatic complications
• mortality
• diagnosis