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Missed Diagnoses and Adverse Outcomes in Older Adults Socially Admitted to the Hospital After Low-Energy Trauma
Lynn Goovaerts1, Gijs J J van Aert2, Philip M J Schormans3
1Department of Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, the Netherlands; Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Limburg, the Netherlands; Department of Geriatrics, Amphia Hospital, Breda, the Netherlands.
Objectives:
To assess the frequency of missed diagnoses and their association with mortality and care escalation among older adults socially admitted to hospital after low-energy trauma.
Design:
Single-center observational cohort study.
Setting And Participants:
Patients aged ≥65 years who were socially admitted via the emergency department after low-energy trauma. Patients with major injuries or clear medical indications for admission were excluded.
Methods:
A missed diagnosis was defined as a clinically relevant condition not identified during initial emergency department assessment but diagnosed after admission and requiring therapeutic intervention. The primary outcome was 180-day all-cause mortality. The secondary outcome was escalation of care needs at discharge. Survival was analyzed using Kaplan-Meier curves and Cox proportional hazards regression, with adjustment for frailty and comorbidity.
Results:
The cohort comprised 130 patients (mean age, 85.3 years; 75.4% female). A missed diagnosis was identified in 30.0% of patients. Mortality at 180 days was 24.6%, and escalation of care needs occurred in 87.2%. Survival was significantly shorter in patients with a missed diagnosis (log-rank P = .002). In multivariable Cox regression analyses, missed diagnosis was independently associated with increased mortality (hazard ratio, 3.06; 95% CI, 1.41-6.68), as was lower body mass index (hazard ratio, 0.89 per kg/m2; 95% CI, 0.81-0.97).
Conclusions And Implications:
Among older adults socially admitted after low-energy trauma, missed diagnoses are common and independently associated with short-term mortality. These findings suggest that social admission may reflect diagnostic vulnerability rather than low clinical risk. For clinical practice, early diagnostic vigilance and structured geriatric assessment during emergency care may be warranted in this population. Future prospective studies are needed to evaluate whether systematic diagnostic strategies can improve outcomes.
