Journal article
An estimate of missed pediatric sepsis in the emergency department
Diagnosis (Berlin, Germany), Vol.8(2), pp.193-198
05/26/2021
DOI: 10.1515/dx-2020-0023
PMCID: PMC7732517
PMID: 32191624
Abstract
Abstract
Background: Timely diagnosis of pediatric sepsis remains elusive. We estimated the risk of potentially missed pediatric sepsis in US emergency departments (EDs) and determined factors associated with its occurrence.
Methods: In a retrospective study of linked inpatient and ED records from four states using administrative data (excluding 40% with missing identifiers), we identified children admitted with severe sepsis and/or septic shock who had at least one ED treat-and-release visit in the 7 days prior to sepsis admission. An expert panel rated the likelihood of each ED visit being related to subsequent sepsis admission. We used multivariable regression to identify associations with potentially missed sepsis.
Results: Of 1945 patients admitted with severe sepsis/septic shock, 158 [8.1%; 95% confidence interval (CI), 6.9%-9.4%] had potentially missed sepsis during an antecedent treat-and-release ED visit. The odds of potentially missed sepsis were lower for each additional comorbid chronic condition [odds ratio (OR), 0.86; 95% CI, 0.80-0.92] and higher in California (OR, 2.26; 95% CI, 1.34-3.82), Florida (OR, 3.33; 95% CI, 1.95-5.70), and Massachusetts (OR, 2.87; 95% CI, 1.35-6.09), compared to New York.
Conclusions: Administrative data can be used to screen large populations for potentially missed sepsis and identify cases that warrant detailed record review.
Keywords: diagnostic error; emergency department; misdiagnosis; pediatrics; sepsis.
©2020 Walter de Gruyter GmbH, Berlin/Boston.
Details
- Title: Subtitle
- An estimate of missed pediatric sepsis in the emergency department
- Creators
- Christina L Cifra - University of Iowa Carver College of Medicine, Iowa City, USAErik Westlund - University of Iowa College of Liberal Arts and Sciences, Department of Sociology, Iowa City, IA, USAPatrick Ten Eyck - University of Iowa Institute for Clinical and Translational Science, Iowa City, IA, USAMarcia M Ward - University of Iowa College of Public Health, Iowa City, IA, USANicholas M Mohr - University of Iowa Carver College of Medicine, Iowa City, USADavid A Katz - Iowa City VA Health Care System, Iowa City, IA, USA
- Resource Type
- Journal article
- Publication Details
- Diagnosis (Berlin, Germany), Vol.8(2), pp.193-198
- DOI
- 10.1515/dx-2020-0023
- PMID
- 32191624
- PMCID
- PMC7732517
- NLM abbreviation
- Diagnosis (Berl)
- ISSN
- 2194-8011
- eISSN
- 2194-802X
- Publisher
- De Gruyter
- Number of pages
- 6
- Language
- English
- Date published
- 05/26/2021
- Academic Unit
- Sociology and Criminology; Health Management and Policy; Stead Family Department of Pediatrics; Epidemiology; Emergency Medicine; Biostatistics; Anesthesia; Injury Prevention Research Center; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984221749302771
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