Do emergency department patients receive a pathological diagnosis? A nationally-representative sample

Area of Science:

• Emergency Medicine
• Diagnostic Accuracy
• Health Services Research

Background:

• Pathological diagnoses are crucial for understanding patient symptoms and guiding treatment.
• Previous studies suggest a significant number of emergency department (ED) patients are discharged without a definitive pathological diagnosis.
• This study investigates trends in pathological diagnoses at ED discharge using national data.

Purpose of the Study:

• To determine the proportion of patients discharged from the ED with a pathological diagnosis for common chief complaints (chest pain, abdominal pain, headache).
• To analyze trends in the rate of pathological discharge diagnoses from 1993 to 2009.
• To identify patient and visit characteristics associated with receiving a pathological diagnosis.

Main Methods:

• Analysis of 17 years (1993-2009) of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS).
• Inclusion of adult patients (≥18 years) discharged from the ED with chief complaints of chest pain, abdominal pain, or headache.
• Categorization of discharge diagnoses as symptomatic or pathological, with trend analysis using logistic regression.

Main Results:

• An estimated 164 million adult ED visits for the studied complaints resulted in discharge home.
• Proportions of pathological discharge diagnoses were 55% (chest pain), 71% (abdominal pain), and 70% (headache).
• The overall proportion of pathological discharge diagnoses decreased from 72% to 63% between 1993 and 2009.

Conclusions:

• A substantial number of patients are discharged from the ED without a pathological diagnosis explaining their symptoms.
• Despite advancements in diagnostics, the rate of pathological discharge diagnoses has declined.
• Further research is needed to understand the reasons for this trend and its impact on clinical outcomes.