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ER Discharge Dx/Disposition Discordant With Chief Complaint

TUESDAY, March 19 (HealthDay News) -- A considerable proportion of patients with emergency department visits with the same presenting complaint as those ultimately given a primary care-treatable diagnosis require immediate emergency care or hospital admission, according to a study published in the March 20 issue of the Journal of the American Medical Association.

Maria C. Raven, M.D., M.P.H., from the University of California San Francisco, and colleagues applied an algorithm to publicly available emergency department visit data from 34,942 unique visits to examine whether presenting complaints and discharge diagnosis correspond adequately to support the use of discharge diagnosis as the basis for policies discouraging emergency department use. The chief presenting complaint was identified for each visit with a primary care-treatable discharge diagnosis, and all emergency department visits with this same group of chief complaints were assessed.

The researchers found that, based on discharge diagnoses, only 6.3 percent of visits were determined to have primary care-treatable diagnoses; however, for 88.7 percent of all emergency department visits, the same chief complaints were reported as those reported for the visits with primary care-treatable emergency department discharge diagnoses. Of these, 11.1 percent needed immediate or emergency care, 12.5 percent required hospital admission, and 3.4 percent of patients were directly to the emergency room.

"Among emergency department visits with the same presenting complaint as those ultimately given a primary care-treatable diagnosis based on emergency department discharge diagnosis, a substantial proportion required immediate emergency care or hospital admission," the authors write. "The limited concordance between presenting complaints and emergency department discharge diagnoses suggests that these discharge diagnoses are unable to accurately identify non-emergency emergency department visits."

Two authors disclosed being consultants on emergency department policies.

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