Incidence, Duration, and Risk Factors Associated With Missed Opportunities to Diagnose Herpes Simplex Encephalitis: A Population-Based Longitudinal Study

Aaron C. Miller; Scott H. Koeneman; Alan T. Arakkal; Joseph E. Cavanaugh; Philip M. Polgreen

doi:10.1093/ofid/ofab400

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Incidence, Duration, and Risk Factors Associated With Missed Opportunities to Diagnose Herpes Simplex Encephalitis: A Population-Based Longitudinal Study

Journal article

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Incidence, Duration, and Risk Factors Associated With Missed Opportunities to Diagnose Herpes Simplex Encephalitis: A Population-Based Longitudinal Study

Aaron C. Miller, Scott H. Koeneman, Alan T. Arakkal, Joseph E. Cavanaugh and Philip M. Polgreen

Open forum infectious diseases, Vol.8(9), pp.ofab400-ofab400

09/01/2021

DOI: 10.1093/ofid/ofab400

PMCID: PMC8415533

PMID: 34514018

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Abstract

Background. Delays in diagnosing herpes simplex encephalitis (HSE) are associated with increased morbidity and mortality. The purpose of this paper is to determine the frequency and duration of diagnostic delays for HSE and risk factors for diagnostic delays. Methods. Using data from the IBM Marketscan Databases, 2001-2017, we performed a retrospective cohort study of patients with HSE. We estimated the number of visits with HSE-related symptoms before diagnosis that would be expected to occur in the absence of delays and compared this estimate to the observed pattern of visits. Next, we used a simulation-based approach to compute the number of visits representing a delay, the number of missed diagnostic opportunities per case patient, and the duration of delays. We also investigated potential risk factors for delays. Results. We identified 2667 patients diagnosed with HSE. We estimated 45.9% (95% confidence interval [CI], 43.6%-48.1%) of patients experienced at least 1 missed opportunity; 21.9% (95% CI, 17.3%-26.3%) of these patients had delays lasting >7 days. Risk factors for delays included being seen only in the emergency department, age <65, or a history of sinusitis or schizophrenia. Conclusions. Many patients with HSE experience multiple missed diagnostic opportunities before diagnosis.

Immunology

Infectious Diseases

Life Sciences & Biomedicine

Microbiology

Science & Technology

Details

Title: Subtitle: Incidence, Duration, and Risk Factors Associated With Missed Opportunities to Diagnose Herpes Simplex Encephalitis: A Population-Based Longitudinal Study
Creators: Aaron C. Miller - University of Iowa
Scott H. Koeneman - University of Iowa
Alan T. Arakkal - University of Iowa
Joseph E. Cavanaugh - University of Iowa
Philip M. Polgreen - University of Iowa
Resource Type: Journal article
Publication Details: Open forum infectious diseases, Vol.8(9), pp.ofab400-ofab400
DOI: 10.1093/ofid/ofab400
PMID: 34514018
PMCID: PMC8415533
NLM abbreviation: Open Forum Infect Dis
ISSN: 2328-8957
eISSN: 2328-8957
Publisher: Oxford University Press
Number of pages: 8
Grant note: R01HS027375 / Agency for Healthcare Research and Quality; United States Department of Health & Human Services; Agency for Healthcare Research & Quality UL1TR002537 / National Center for Advancing Translational Sciences; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS)
Language: English
Date published: 09/01/2021
Academic Unit: Statistics and Actuarial Science; Infectious Diseases; Epidemiology; Biostatistics; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9984359874802771

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