The risk of missed diagnosis of acute myocardial infarction associated with emergency department volume
Abstract
STUDY OBJECTIVE: Missed diagnosis of acute myocardial infarction is associated with adverse clinical outcomes and more dollars recovered in malpractice suits than any other condition. The rate of missed diagnosis varies between emergency departments (EDs); we hypothesized that it is associated with the volume of acute myocardial infarction patients treated in an ED and that the association can be explained by other hospital characteristics.
METHODS: We linked the records of all acute myocardial infarction patients admitted to an Ontario hospital in 2002 to 2003 to their ED visit records in the 7 days preceding admission. Acute myocardial infarctions were defined as missed if the diagnosis on the previous visit matched a list of cardiac symptoms and illnesses. We assessed whether annual volume of admitted acute myocardial infarction patients treated in the ED (grouped as 0 to 49; 50 to 99; 100 to 199; 200 to 299; and > or = 300) was associated with missed acute myocardial infarction, adjusting for age, sex, teaching hospital status, and acute myocardial infarction severity. In a secondary analysis, we used data from a survey of Ontario EDs to assess whether hospital characteristics (triage practices, use of diagnostic tests, and consultant availability) explained the volume association.
RESULTS: Of 19,663 acute myocardial infarction patients, mean age (68.3 years), sex (63% men), and predicted 1-year mortality (mean 0.21; SD 0.18) were similar across volume groups. The rate…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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