In-hospital mortality associated with the misdiagnosis or unidentified site of infection at admission

Toshikazu Abe, Yasuharu Tokuda, Atsushi Shiraishi, Seitaro Fujishima, Toshihiko Mayumi, Takehiro Sugiyama, Gautam A. Deshpande, Yasukazu Shiino, Toru Hifumi, Yasuhiro Otomo, Kohji Okamoto, Joji Kotani, Yuichiro Sakamoto, Junichi Sasaki, Shin Ichiro Shiraishi, Kiyotsugu Takuma, Akiyoshi Hagiwara, Kazuma Yamakawa, Naoshi Takeyama, Satoshi Gando & 22 others Takashi Muroya, Kaoru Koike, Hideaki Anan, Manabu Sugita, Yasuo Miki, Hisashi Yamashita, Hirotada Kittaka, Junichi Maehara, Sho Nachi, Kazuma Morino, Atsumi Hoshino, Hiroyuki Yamaguchi, Masahiro Harada, Hiroyasu Ishikura, Masato Kawakami, Yoshizumi Deguchi, Hideaki Yoshihara, Yoshihiro Hanaki, Kunihiko Okada, Tadashi Kaneko, Kazuya Kiyota, Yoshihiro Shimizu

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Rapid detection, early resuscitation, and appropriate antibiotic use are crucial for sepsis care. Accurate identification of the site of infection may facilitate a timely provision of appropriate care. We aimed to investigate the relationship between misdiagnosis of the site of infection at initial examination and in-hospital mortality. Methods: This was a secondary-multicenter prospective cohort study involving 37 emergency departments. Consecutive adult patients with infection from December 2017 to February 2018 were included. Misdiagnosis of the site of infection was defined as a discrepancy between the suspected site of infection at initial examination and that at final diagnosis, including those infections remaining unidentified during hospital admission, whereas correct diagnosis was defined as site concordance. In-hospital mortality was compared between those misdiagnosed and those correctly diagnosed. Results: Of 974 patients included in the analysis, 11.6% were misdiagnosed. Patients diagnosed with lung, intra-abdominal, urinary, soft tissue, and CNS infection at the initial examination, 4.2%, 3.8%, 13.6%, 10.9%, and 58.3% respectively, turned out to have an infection at a different site. In-hospital mortality occurred in 15%. In both generalized estimating equation (GEE) and propensity score-matched models, misdiagnosed patients exhibited higher mortality despite adjustment for patient background, site infection, and severity. The adjusted odds ratios (misdiagnosis vs. correct diagnosis) for in-hospital mortality were 2.66 (95% CI, 1.45-4.89) in the GEE model and 3.03 (95% CI, 1.24-7.38) in the propensity score-matched model. The difference in the absolute risk in the GEE model was 0.11 (0.04-0.18). Conclusions: Among patients with infection, misdiagnosed site of infection is associated with a > 10% increase in in-hospital mortality.

Original languageEnglish
Article number202
JournalCritical Care
Volume23
Issue number1
DOIs
Publication statusPublished - 2019 Jun 6

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Hospital Mortality
Diagnostic Errors
Infection
Propensity Score
Soft Tissue Infections
Resuscitation
Hospital Emergency Service
Sepsis
Cohort Studies
Odds Ratio
Prospective Studies
Anti-Bacterial Agents
Lung
Mortality

Keywords

  • Diagnosis
  • Infection
  • Sepsis
  • Source

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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In-hospital mortality associated with the misdiagnosis or unidentified site of infection at admission. / Abe, Toshikazu; Tokuda, Yasuharu; Shiraishi, Atsushi; Fujishima, Seitaro; Mayumi, Toshihiko; Sugiyama, Takehiro; Deshpande, Gautam A.; Shiino, Yasukazu; Hifumi, Toru; Otomo, Yasuhiro; Okamoto, Kohji; Kotani, Joji; Sakamoto, Yuichiro; Sasaki, Junichi; Shiraishi, Shin Ichiro; Takuma, Kiyotsugu; Hagiwara, Akiyoshi; Yamakawa, Kazuma; Takeyama, Naoshi; Gando, Satoshi; Muroya, Takashi; Koike, Kaoru; Anan, Hideaki; Sugita, Manabu; Miki, Yasuo; Yamashita, Hisashi; Kittaka, Hirotada; Maehara, Junichi; Nachi, Sho; Morino, Kazuma; Hoshino, Atsumi; Yamaguchi, Hiroyuki; Harada, Masahiro; Ishikura, Hiroyasu; Kawakami, Masato; Deguchi, Yoshizumi; Yoshihara, Hideaki; Hanaki, Yoshihiro; Okada, Kunihiko; Kaneko, Tadashi; Kiyota, Kazuya; Shimizu, Yoshihiro.

In: Critical Care, Vol. 23, No. 1, 202, 06.06.2019.

Research output: Contribution to journalArticle

Abe, T, Tokuda, Y, Shiraishi, A, Fujishima, S, Mayumi, T, Sugiyama, T, Deshpande, GA, Shiino, Y, Hifumi, T, Otomo, Y, Okamoto, K, Kotani, J, Sakamoto, Y, Sasaki, J, Shiraishi, SI, Takuma, K, Hagiwara, A, Yamakawa, K, Takeyama, N, Gando, S, Muroya, T, Koike, K, Anan, H, Sugita, M, Miki, Y, Yamashita, H, Kittaka, H, Maehara, J, Nachi, S, Morino, K, Hoshino, A, Yamaguchi, H, Harada, M, Ishikura, H, Kawakami, M, Deguchi, Y, Yoshihara, H, Hanaki, Y, Okada, K, Kaneko, T, Kiyota, K & Shimizu, Y 2019, 'In-hospital mortality associated with the misdiagnosis or unidentified site of infection at admission', Critical Care, vol. 23, no. 1, 202. https://doi.org/10.1186/s13054-019-2475-9
Abe, Toshikazu ; Tokuda, Yasuharu ; Shiraishi, Atsushi ; Fujishima, Seitaro ; Mayumi, Toshihiko ; Sugiyama, Takehiro ; Deshpande, Gautam A. ; Shiino, Yasukazu ; Hifumi, Toru ; Otomo, Yasuhiro ; Okamoto, Kohji ; Kotani, Joji ; Sakamoto, Yuichiro ; Sasaki, Junichi ; Shiraishi, Shin Ichiro ; Takuma, Kiyotsugu ; Hagiwara, Akiyoshi ; Yamakawa, Kazuma ; Takeyama, Naoshi ; Gando, Satoshi ; Muroya, Takashi ; Koike, Kaoru ; Anan, Hideaki ; Sugita, Manabu ; Miki, Yasuo ; Yamashita, Hisashi ; Kittaka, Hirotada ; Maehara, Junichi ; Nachi, Sho ; Morino, Kazuma ; Hoshino, Atsumi ; Yamaguchi, Hiroyuki ; Harada, Masahiro ; Ishikura, Hiroyasu ; Kawakami, Masato ; Deguchi, Yoshizumi ; Yoshihara, Hideaki ; Hanaki, Yoshihiro ; Okada, Kunihiko ; Kaneko, Tadashi ; Kiyota, Kazuya ; Shimizu, Yoshihiro. / In-hospital mortality associated with the misdiagnosis or unidentified site of infection at admission. In: Critical Care. 2019 ; Vol. 23, No. 1.
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abstract = "Background: Rapid detection, early resuscitation, and appropriate antibiotic use are crucial for sepsis care. Accurate identification of the site of infection may facilitate a timely provision of appropriate care. We aimed to investigate the relationship between misdiagnosis of the site of infection at initial examination and in-hospital mortality. Methods: This was a secondary-multicenter prospective cohort study involving 37 emergency departments. Consecutive adult patients with infection from December 2017 to February 2018 were included. Misdiagnosis of the site of infection was defined as a discrepancy between the suspected site of infection at initial examination and that at final diagnosis, including those infections remaining unidentified during hospital admission, whereas correct diagnosis was defined as site concordance. In-hospital mortality was compared between those misdiagnosed and those correctly diagnosed. Results: Of 974 patients included in the analysis, 11.6{\%} were misdiagnosed. Patients diagnosed with lung, intra-abdominal, urinary, soft tissue, and CNS infection at the initial examination, 4.2{\%}, 3.8{\%}, 13.6{\%}, 10.9{\%}, and 58.3{\%} respectively, turned out to have an infection at a different site. In-hospital mortality occurred in 15{\%}. In both generalized estimating equation (GEE) and propensity score-matched models, misdiagnosed patients exhibited higher mortality despite adjustment for patient background, site infection, and severity. The adjusted odds ratios (misdiagnosis vs. correct diagnosis) for in-hospital mortality were 2.66 (95{\%} CI, 1.45-4.89) in the GEE model and 3.03 (95{\%} CI, 1.24-7.38) in the propensity score-matched model. The difference in the absolute risk in the GEE model was 0.11 (0.04-0.18). Conclusions: Among patients with infection, misdiagnosed site of infection is associated with a > 10{\%} increase in in-hospital mortality.",
keywords = "Diagnosis, Infection, Sepsis, Source",
author = "Toshikazu Abe and Yasuharu Tokuda and Atsushi Shiraishi and Seitaro Fujishima and Toshihiko Mayumi and Takehiro Sugiyama and Deshpande, {Gautam A.} and Yasukazu Shiino and Toru Hifumi and Yasuhiro Otomo and Kohji Okamoto and Joji Kotani and Yuichiro Sakamoto and Junichi Sasaki and Shiraishi, {Shin Ichiro} and Kiyotsugu Takuma and Akiyoshi Hagiwara and Kazuma Yamakawa and Naoshi Takeyama and Satoshi Gando and Takashi Muroya and Kaoru Koike and Hideaki Anan and Manabu Sugita and Yasuo Miki and Hisashi Yamashita and Hirotada Kittaka and Junichi Maehara and Sho Nachi and Kazuma Morino and Atsumi Hoshino and Hiroyuki Yamaguchi and Masahiro Harada and Hiroyasu Ishikura and Masato Kawakami and Yoshizumi Deguchi and Hideaki Yoshihara and Yoshihiro Hanaki and Kunihiko Okada and Tadashi Kaneko and Kazuya Kiyota and Yoshihiro Shimizu",
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month = "6",
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T1 - In-hospital mortality associated with the misdiagnosis or unidentified site of infection at admission

AU - Abe, Toshikazu

AU - Tokuda, Yasuharu

AU - Shiraishi, Atsushi

AU - Fujishima, Seitaro

AU - Mayumi, Toshihiko

AU - Sugiyama, Takehiro

AU - Deshpande, Gautam A.

AU - Shiino, Yasukazu

AU - Hifumi, Toru

AU - Otomo, Yasuhiro

AU - Okamoto, Kohji

AU - Kotani, Joji

AU - Sakamoto, Yuichiro

AU - Sasaki, Junichi

AU - Shiraishi, Shin Ichiro

AU - Takuma, Kiyotsugu

AU - Hagiwara, Akiyoshi

AU - Yamakawa, Kazuma

AU - Takeyama, Naoshi

AU - Gando, Satoshi

AU - Muroya, Takashi

AU - Koike, Kaoru

AU - Anan, Hideaki

AU - Sugita, Manabu

AU - Miki, Yasuo

AU - Yamashita, Hisashi

AU - Kittaka, Hirotada

AU - Maehara, Junichi

AU - Nachi, Sho

AU - Morino, Kazuma

AU - Hoshino, Atsumi

AU - Yamaguchi, Hiroyuki

AU - Harada, Masahiro

AU - Ishikura, Hiroyasu

AU - Kawakami, Masato

AU - Deguchi, Yoshizumi

AU - Yoshihara, Hideaki

AU - Hanaki, Yoshihiro

AU - Okada, Kunihiko

AU - Kaneko, Tadashi

AU - Kiyota, Kazuya

AU - Shimizu, Yoshihiro

PY - 2019/6/6

Y1 - 2019/6/6

N2 - Background: Rapid detection, early resuscitation, and appropriate antibiotic use are crucial for sepsis care. Accurate identification of the site of infection may facilitate a timely provision of appropriate care. We aimed to investigate the relationship between misdiagnosis of the site of infection at initial examination and in-hospital mortality. Methods: This was a secondary-multicenter prospective cohort study involving 37 emergency departments. Consecutive adult patients with infection from December 2017 to February 2018 were included. Misdiagnosis of the site of infection was defined as a discrepancy between the suspected site of infection at initial examination and that at final diagnosis, including those infections remaining unidentified during hospital admission, whereas correct diagnosis was defined as site concordance. In-hospital mortality was compared between those misdiagnosed and those correctly diagnosed. Results: Of 974 patients included in the analysis, 11.6% were misdiagnosed. Patients diagnosed with lung, intra-abdominal, urinary, soft tissue, and CNS infection at the initial examination, 4.2%, 3.8%, 13.6%, 10.9%, and 58.3% respectively, turned out to have an infection at a different site. In-hospital mortality occurred in 15%. In both generalized estimating equation (GEE) and propensity score-matched models, misdiagnosed patients exhibited higher mortality despite adjustment for patient background, site infection, and severity. The adjusted odds ratios (misdiagnosis vs. correct diagnosis) for in-hospital mortality were 2.66 (95% CI, 1.45-4.89) in the GEE model and 3.03 (95% CI, 1.24-7.38) in the propensity score-matched model. The difference in the absolute risk in the GEE model was 0.11 (0.04-0.18). Conclusions: Among patients with infection, misdiagnosed site of infection is associated with a > 10% increase in in-hospital mortality.

AB - Background: Rapid detection, early resuscitation, and appropriate antibiotic use are crucial for sepsis care. Accurate identification of the site of infection may facilitate a timely provision of appropriate care. We aimed to investigate the relationship between misdiagnosis of the site of infection at initial examination and in-hospital mortality. Methods: This was a secondary-multicenter prospective cohort study involving 37 emergency departments. Consecutive adult patients with infection from December 2017 to February 2018 were included. Misdiagnosis of the site of infection was defined as a discrepancy between the suspected site of infection at initial examination and that at final diagnosis, including those infections remaining unidentified during hospital admission, whereas correct diagnosis was defined as site concordance. In-hospital mortality was compared between those misdiagnosed and those correctly diagnosed. Results: Of 974 patients included in the analysis, 11.6% were misdiagnosed. Patients diagnosed with lung, intra-abdominal, urinary, soft tissue, and CNS infection at the initial examination, 4.2%, 3.8%, 13.6%, 10.9%, and 58.3% respectively, turned out to have an infection at a different site. In-hospital mortality occurred in 15%. In both generalized estimating equation (GEE) and propensity score-matched models, misdiagnosed patients exhibited higher mortality despite adjustment for patient background, site infection, and severity. The adjusted odds ratios (misdiagnosis vs. correct diagnosis) for in-hospital mortality were 2.66 (95% CI, 1.45-4.89) in the GEE model and 3.03 (95% CI, 1.24-7.38) in the propensity score-matched model. The difference in the absolute risk in the GEE model was 0.11 (0.04-0.18). Conclusions: Among patients with infection, misdiagnosed site of infection is associated with a > 10% increase in in-hospital mortality.

KW - Diagnosis

KW - Infection

KW - Sepsis

KW - Source

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U2 - 10.1186/s13054-019-2475-9

DO - 10.1186/s13054-019-2475-9

M3 - Article

VL - 23

JO - Critical Care

JF - Critical Care

SN - 1364-8535

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M1 - 202

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