Agreement Between Emergency Department Admission and Hospital Discharge Diagnoses; A Retrospective Observational Study
Archives of Academic Emergency Medicine,
Vol. 13 No. 1 (2025),
6 September 2025
,
Page e52
https://doi.org/10.22037/aaemj.v13i1.2597
Abstract
Introduction: An accurate emergency department (ED) diagnosis is critically important for providing proper treatment during the so-called “Golden Hour.” This study aimed to evaluate the agreement between admitting and discharge diagnoses in ED.
Method: This retrospective cross-sectional study was conducted over the course of 6 months in the emergency department (ED) of a tertiary care center. The main aim of the study was to evaluate the agreement between admission and hospital discharge diagnoses. The patients were categorized into two groups based on whether the admitting and discharge diagnoses were matched or mismatched. The reasons for diagnostic discrepancies, as well as their impact on patient outcomes, were assessed.
Results: A total of 6812 cases with mean age of 43.2 ± 17.9 (range: 1–95 years) years were included (59.30% male). The admitting and discharge diagnoses were matched in 5585 (81.99%) cases and mismatched in 1227 (18.01%) cases (7.2% were completely unmatched). The proportion of mismatched diagnoses did not differ significantly between males and females (p = 0.0977). Mismatched diagnoses were significantly more common in 0–15 years age group (37.86%), and the lowest proportion was seen in patients aged 15–65 years (9.65%) (p < 0.001). The most frequent reason for diagnostic discrepancy was “writing chronic disease as discharge diagnosis (relabeling),” (37.08%). Other contributing factors included radiological tests after hospital admission (20.37%), physical examination findings (18.1%), additional laboratory tests (15.81%), and other causes (8.57%). A change in diagnosis impacted the clinical outcomes of 103 (8.39%) patients.
Conclusion: Diagnostic agreement between ED and discharge diagnoses was observed in 81.99% of cases, with a 7.2% complete mismatch rate. The most frequent causes were discharge relabeling and delayed investigations. These discrepancies had measurable impacts on management, hospital stay, and mortality.
- Emergency service, hospital
- Diagnosis, differential
- Diagnostic errors
- Hospital records
- Retrospective studies
How to Cite
References
Chiu H, Chan K, Chung C, Ma K, Au K. A comparison of emergency department admission diagnoses and discharge diagnoses: retrospective study. Hong Kong J Emerg Med. 2003;10(2):70-5.
Abuguyan F, Alanazi Y, Alshabib L, Alyahya B, Alalshaikh A, Al-Salamah T, et al. Discrepancy between emergency department diagnoses and discharge diagnoses in a tertiary center in KSA. Signa Vitae. 2024;20(8):81-8.
Bastakoti M, Muhailan M, Nassar A, Sallam T, Desale S, Fouda R, et al. Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality. Diagnosis (Berl). 2021;9(1):107-14.
Avelino-Silva TJ, Steinman MA. Diagnostic discrepancies between emergency department admissions and hospital discharges among older adults: secondary analysis on a population-based survey. Sao Paulo Med J. 2020;138(5):359-67.
Fatima S, Shamim S, Butt AS, Awan S, Riffat S, Tariq M. The discrepancy between admission and discharge diagnoses: Underlying factors and potential clinical outcomes in a low socioeconomic country. PLoS One. 2021;16(6):e0253316.
Manohar S, Gore S, Chaturvedi G. Diagnostic Accuracy in the Emergency Department: A Comparative Analysis of Initial and Final Diagnoses at Discharge. Indian Pract. 2025;78(03):12-5.
Zhang D, Yan B, He S, Tong S, Huang P, Zhang Q, et al. Diagnostic consistency between admission and discharge of pediatric cases in a tertiary teaching hospital in China. BMC Pediatr. 2023;23(1):176.
Schols LA, Maranus ME, Rood PPM, Zwaan L. Diagnostic Discrepancies in the Emergency Department: A Retrospective Study. J Patient Saf. 2024;20(6):420-5.
Hautz WE, Kämmer JE, Hautz SC, Sauter TC, Zwaan L, Exadaktylos AK, et al. Diagnostic error increases mortality and length of hospital stay in patients presenting through the emergency room. Scand J Trauma Resusc Emerg Med. 2019;27(1):54.
Eames J, Eisenman A, Schuster RJ. Disagreement between emergency department admission diagnosis and hospital discharge diagnosis: mortality and morbidity. Diagnosis (Berl). 2016;3(1):23-30.
Mihailovic N, Vasiljevic D, Milicic V, Luketina Sunjka M, Radovanovi S, Milicic B, et al. Discrepancy between Admission and Discharge Diagnoses in Central Serbia: Analysis by the Groups of International Classification of Diseases, 10th Revision. Iran J Public Health. 2020;49(12):2348-55.
- Abstract Viewed: 311 times
- pdf Downloaded: 837 times
Download Statastics
Make a Submission
SJR
COPE
