213 High Diagnostic Uncertainty and Inaccuracy in Older Adult Emergency Department Patients With Dyspnea

Abstract

Dyspnea is one of the most common chief complaints among emergency department (ED) by older adults and is an independent predictor of mortality. The accurate diagnosis of dyspnea in older adults presents a challenge to emergency physicians. We describe the degree of diagnostic uncertainty and inaccurate diagnosis among the three most common causes of dyspnea: pneumonia, chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) in a national dataset. National Hospital Ambulatory Medical Care Survey (NHAMCS) data from 2009-2013 were analyzed. Among visits by individuals aged 65 years and older with reason for visit codes consistent with dyspnea, we estimated the survey-weighted proportion of visits in which patients were diagnosed with pneumonia, CHF, and/or COPD to describe rates of co-diagnosis. Among admitted patients, we examined ED discharge diagnosis agreement with hospital discharge diagnosis. There were 12.5 million ED visits nationally for dyspnea in older adult patients from 2009-2013, or 2.5 million visits per year. Of all dyspneic patients, 16% (95% Confidence Interval (CI) 14-18%) were diagnosed with >1 of pneumonia, COPD, and CHF with 33% (95% CI 30-36%) with “dyspnea not otherwise specified.” Among the 56% admitted to the hospital, 92% (95% CI 90-94%) had a hospital discharge diagnosis different than ED diagnosis. Older adults frequently present to the emergency department with shortness of breath or dyspnea and suffer from diagnostic uncertainty and inaccurate diagnosis. As ED care is known to profoundly impact subsequent care, improved ED diagnostic accuracy is necessary to improve morbidity and mortality among older adults ED patients and inpatients presenting with dyspnea.