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Table 1 Scheme to classify a pair of diagnoses from ER (admission) and IM (discharge), extended from [46]

From: Diagnostic error increases mortality and length of hospital stay in patients presenting through the emergency room

Outcome

Discharge Diagnosis is

Frequency

Explanation

Example

Without diagnostic discrepancy

Identical

436 (57.7%)

The two diagnoses are either verbatim or medically identical.

More precise

190 (25.2%)

The IM discharge diagnosis is more precise than the ER diagnosis (e.g., by adding an established, disease-specific score or the result of a test that was not available at the ER).

ER diagnosis: atrial Fibrillation

IM diagnosis: atrial Fibrillation,

CHADS2-Score 4

A complication

36 (4.8%)

The primary discharge diagnosis from the IM was not foreseeable at the time of hospital admission at the ER but became the most prominent during hospitalization.

ER diagnosis: hospital acquired Pneumonia

IM diagnosis:

1) acute septic ischemia of both legs

2) Legionella pneumonia

With diagnostic discrepancy

Hierarchically different

25 (3.3%)

The primary ER diagnosis is listed among the IM discharge diagnoses but is not the primary discharge diagnosis.

ER diagnosis:

1) Recurrent falls 2) Gastroenteritis

IM diagnosis: 1) Femoral neck fracture*

2) Recurrent falls 3) Gastroenteritis

Diagnostically different

68 (9.0%)

The primary ER diagnosis is not among the IM discharge diagnoses.

ER diagnosis: acute on chronic obstipation

IM diagnosis: acute pancreatitis

  1. *No further falls after admittance. ER: emergency room; IM: internal medicine