Objective: To evaluate rates, risk factors and outcomes of delayed diagnosis of seven serious paediatric conditions.

Methods: This was a retrospective, cross-sectional study of children under 21 years old visiting 13 community and tertiary emergency departments (EDs) with appendicitis, bacterial meningitis, intussusception, mastoiditis, ovarian torsion, sepsis or testicular torsion. Delayed diagnosis was defined as having a previous ED encounter within 1 week in which the condition was present per case review. Patients with delayed diagnosis were each matched to four control patients without delay by condition, facility and age. Conditional logistic regression models evaluated risk factors of delay. Complications were compared between by delayed diagnosis status.

Results: Among 14 972 children, delayed diagnosis occurred in 1.1% (range 0.3% for sepsis to 2.6% for ovarian torsion). Hispanic (matched OR 2.71, 95% CI 1.69 to 4.35) and non-Hispanic black (OR 2.40, 95% CI 1.21 to 4.79) race/ethnicity were associated with delayed diagnosis, whereas Asian and other race/ethnicity were not. Public (OR 2.21, 95% CI 1.42 to 3.44) and other (OR 2.43, 95% CI 1.50 to 3.93) insurance were also associated with delay. Non-English language was associated with delay (OR 1.65, 95% CI 1.02 to 2.69). Abnormal vital signs were associated with a lower likelihood of delay (OR 0.15, 95% CI 0.09 to 0.25). In an adjusted model, Hispanic race/ethnicity, other insurance, abnormal vital signs and complex chronic conditions (CCCs) were associated with delay. The odds of a complication were 2.5-fold (95% CI 1.6 to 3.8) higher among patients with a delay.

Conclusion: Delayed diagnosis was uncommon across 13 regional EDs but was more likely among children with Hispanic ethnicity, CCCs or normal vital signs. Delays were associated with a higher risk of complications.

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjqs-2022-015314DOI Listing

Publication Analysis

Top Keywords

delayed diagnosis
32
associated delay
12
vital signs
12
delayed
8
diagnosis serious
8
serious paediatric
8
emergency departments
8
risk factors
8
ovarian torsion
8
abnormal vital
8

Similar Publications

Primary Raynaud's phenomenon (RP) is a common and self-limiting condition, which is not secondary to any other disease process. In contrast, secondary RP has an underlying etiology. Several conditions can lead to secondary RP, which creates a challenging landscape for clinicians.

View Article and Find Full Text PDF

Tracheal tumors in pediatric patients are rare, accounting for 2% of all airway abnormalities and 0.2% of all pediatric tumors. Diagnosis is often delayed due to the heterogeneity of presenting symptoms, such as stridor and wheezing, which are frequently misattributed to other conditions.

View Article and Find Full Text PDF

Connective tissue disease associated pulmonary arterial hypertension (CTD-PAH) has benefited from the major treatment advances that have occurred within pulmonary hypertension over the past three decades. Inclusion of CTD-PAH cases in pivotal clinical trials led to regulatory approval and drug availability. This has improved outcomes but there are additional challenges for management.

View Article and Find Full Text PDF

Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal surgeries performed in the US but is associated with various morbidities. Esophageal perforation is one of the rarest complications of ACDF, but it is potentially fatal, therefore requiring timely detection and treatment. We present three cases of esophageal perforation after ACDF.

View Article and Find Full Text PDF

Differences between hepatocellular carcinoma caused by alcohol and other aetiologies.

J Hepatol

December 2024

AP-HP, Hôpital Avicenne, Liver Unit, F-93000 Bobigny, France; University Sorbonne Paris Nord, UFR SMBH, F-93000 Bobigny, France; INSERM UMR-1168, Functional Genomics of Solid Tumours, F-75006 Paris, France.

Alcohol-related liver disease is the third cause of hepatocellular carcinoma worldwide and the leading cause in Europe. Additionally, the recent definition of Metabolic dysfunction-Associated Steatotic Liver Disease with increased alcoholic intake will enrich this population with a more nuanced phenotype, reflecting recent epidemiological trends. In these patients, hepatocellular carcinoma diagnosis is often delayed and less frequently detected through screening programs.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!