Initial vs. final diagnosis in non-traumatic patients presented to the emergency department; a prospective cohort study

Aim: In the emergency department (ED), some patients are discharged following initial diagnosis and treatment, whereas others are hospitalized for treatment and/or further diagnostic examination. The ED physician usually does not receive feedback regarding the accuracy of their diagnosis, the effectiveness of the treatment, or the morbidity/mortality of the patient. In this study, we follow up with non-traumatic ED patients in order to obtain data regarding these subjects.
Materials and Methods: This prospective cohort study includes all non-traumatic patients that were admitted to the ED of a tertiary hospital during a two-month time frame that were hospitalized in various clinics. The following data were recorded for each patient: demographic information, vital signs, diagnosis at the time of admission, diagnosis after hospitalization, length of stay, mortality and complications.
Results: This study includes a total of 740 patients that met the inclusion criteria. Mean age was 54 years, 398 patients (53.8%) were male. The initial diagnosis of 22 patients (2.9%) changed after further examinations. The mean age of these patients were 42, and 11 patients were male (50%). Emergency invasive intervention was significantly more common among patients with changed diagnosis (cDx) (40.9% vs. 4.1%, p <0.001). Consequently, the incidence of complications was higher in cDx patients (31.8% vs. 10.8%, p = 0.01).
Conclusion: Majority of the patients that were hospitalized from the ED were treated with their initial diagnosis and in the initial department of hospitalization. We conclude that the ED functions at an adequate accuracy despite their high workload.