Are Mental Health and Substance Use Disorders Risk Factors for Missed Acute Myocardial Infarction Diagnoses Among Chest Pain or Dyspnea Encounters in the Emergency Department?

被引：8

作者：

Sharp, Adam L. ^{[1
,2
,3
,4
]}

Pallegadda, Rani ^{[3
,4
]}

Baecker, Aileen ^{[1
]}

Park, Stacy ^{[1
]}

Nassery, Najlla ^{[5
]}

Hassoon, Ahmed ^{[6
]}

Peterson, Susan ^{[7
]}

Pitts, Samantha, I ^{[5
]}

Wang, Zheyu ^{[8
,9
]}

Zhu, Yuxin ^{[8
,9
]}

Newman-Toker, David E. ^{[6
,7
,10
]}

机构：

[1] Kaiser Permanente Southern Calif, Dept Res & Evaluat, Pasadena, CA 91107 USA

[2] Kaiser Permanente Bernard J Tyson Sch Med, Dept Hlth Syst Sci, Pasadena, CA 91101 USA

[3] Los Angeles Med Ctr, Kaiser Permanente Southern Calif, Dept Emergency Med, Los Angeles, CA 90027 USA

[4] Kaiser Permanente Bernard J Tyson Sch Med, Dept Clin Sci, Pasadena, CA 91101 USA

[5] Johns Hopkins Univ, Sch Med, Div Gen Internal Med, Dept Internal Med, Baltimore, MD USA

[6] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA

[7] Johns Hopkins Univ, Dept Emergency Med, Sch Med, Baltimore, MD USA

[8] Johns Hopkins Univ, Sch Med, Div Biostat & Bioinformat, Baltimore, MD USA

[9] Johns Hopkins Univ, Dept Biostat, Baltimore, MD 21205 USA

[10] Johns Hopkins Univ, Sch Med, Dept Neurol, Baltimore, MD 21205 USA

来源：

ANNALS OF EMERGENCY MEDICINE | 2022年 / 79卷 / 02期

关键词：

MALPRACTICE CLAIMS; MORTALITY; QUALITY; CARE; PHYSICIAN; DISEASE; ILLNESS; DEATH; RATES;

D O I：

10.1016/j.annemergmed.2021.08.016

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Study objective: To assess if having a mental health and/or substance use disorder is associated with a missed acute myocardial infarction diagnosis in the emergency department (ED). Methods: This was a retrospective cohort analysis (2009 to 2017) of adult ED encounters at Kaiser Permanente Southern California. We used the validated symptom-disease pair analysis of diagnostic error methodological approach to "look back" and "look forward" and identify missed acute myocardial infarctions within 30 days of a treat-and-release ED visit. We use adjusted logistic regression to report the odds of missed acute myocardial infarction among patients with a history of mental health and/or substance use disorders. Results: The look-back analysis identified 44,473 acute myocardial infarction hospital encounters; 574 (1.3%) diagnoses were missed. The odds of missed diagnoses were higher in patients with mental health disorders (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.23 to 1.77) but not in those with substance abuse disorders (OR 1.22, 95% CI 0.91 to 1.62). The highest risk was observed in those with co-occurring disorders (OR 1.90, 95% CI 1.30 to 2.76). The look-forward analysis identified 325,088 chest pain/dyspnea ED encounters; 508 (0.2%) were missed acute myocardial infarctions. No significant associations of missed acute myocardial infarction were revealed in either group (mental health disorder: OR 0.92, 95% CI 0.71 to 1.18; substance use disorder: OR 1.22, 95% CI 0.80 to 1.85). Conclusion: The look-back analysis identified patients with mental illness at increased risk of missed acute myocardial infarction diagnosis, with the highest risk observed in those with a history of comorbid substance abuse. Having substance use disorders alone did not increase this risk in either cohort. The look-forward analysis revealed challenges in prospectively identifying high-risk patients to target for improvement.

引用

页码：93 / 101

页数：9

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