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Missed Diagnosis of New-Onset Systolic Heart Failure at First Presentation in Children with No Known Heart Disease.
Puri, Kriti; Singh, Hardeep; Denfield, Susan W; Cabrera, Antonio G; Dreyer, William J; Tunuguntla, Hari P; Price, Jack F.
Afiliação
  • Puri K; Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Houston, TX. Electronic address: puri.kriti@gmail.com.
  • Singh H; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX.
  • Denfield SW; Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Houston, TX.
  • Cabrera AG; Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Houston, TX.
  • Dreyer WJ; Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Houston, TX.
  • Tunuguntla HP; Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Houston, TX.
  • Price JF; Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Houston, TX.
J Pediatr ; 208: 258-264.e3, 2019 05.
Article em En | MEDLINE | ID: mdl-30679055
OBJECTIVE: To determine frequency of missed heart failure diagnosis at first presentation among children with no known heart disease admitted with new-onset heart failure. STUDY DESIGN: Using a retrospective design, we reviewed electronic medical records of all patients aged <21 years with no known heart disease, hospitalized with new-onset heart failure during 2003-2015 at a tertiary-quaternary care institution. We assessed records for missed diagnosis of heart failure (primary outcome), associated process breakdowns, and clinical outcomes using a structured data collection instrument. RESULTS: Of 191 patients meeting inclusion criteria, 49% (94/191) were missed on first presentation. Most common incorrect diagnostic labels given to "missed" patients were bacterial infection (29%; 27/94), followed by viral illness (22%; 21/94) and gastroenteritis/hepatitis (21%; 20/94). On multivariable analysis, presentation to primary care provider (PCP), longer duration of symptoms (median 7 days), more than 2 symptoms of heart failure, and nausea/emesis were associated with missed diagnosis. On examining process breakdowns, 49% had errors in history-taking and 50% had no documentation of differential diagnoses. There was no difference in hospital mortality, length of stay, or mechanical circulatory support in missed vs not-missed cohorts. Unnecessary noninvasive and invasive tests were performed in 18% and 4% of patients, respectively. CONCLUSIONS: Nearly one-half of children with no known heart disease hospitalized with systolic heart failure were missed at first presentation and underwent significant nonrelevant treatment and testing. Initial presentation to the PCP, longer duration of symptoms before presentation, and nausea/emesis were associated with missed diagnosis.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Insuficiência Cardíaca Sistólica / Diagnóstico Ausente Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies Limite: Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: J Pediatr Ano de publicação: 2019 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Insuficiência Cardíaca Sistólica / Diagnóstico Ausente Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies Limite: Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: J Pediatr Ano de publicação: 2019 Tipo de documento: Article País de publicação: Estados Unidos