SHM Converge Scientific Abstract ePoster Gallery-Is Sepsis More Prone to Diagnostic Errors? A Secondary Analysis of the Utility of Predictive Systems for Diagnostic Errors (Upside) Study

Is Sepsis More Prone to Diagnostic Errors? A Secondary Analysis of the Utility of Predictive Systems for Diagnostic Errors (Upside) Study

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In this multicenter secondary analysis of the UPSIDE study, researchers examined whether hospitalized medicine patients with sepsis were more likely to experience diagnostic errors (DE) than patients without sepsis. The study included 2,428 patients from 29 academic medical centers who either died or were transferred to the ICU in 2019. Two physicians reviewed selected cases to determine whether a diagnostic error occurred and whether any of 50 diagnostic process faults were present.<br /><br />More than half of the patients, 1,218 (50.1%), had a primary discharge diagnosis of sepsis. Among these sepsis patients, 272 (22.3%) experienced a diagnostic error. Patients with sepsis tended to be older, more often female, more likely to arrive through the emergency department, and more likely to die during hospitalization. They also had more chronic illness, communication barriers, and altered mental status.<br /><br />After adjusting for patient characteristics and diagnostic process faults, sepsis was not associated with a higher overall risk of diagnostic error (adjusted risk ratio 1.01, 95% CI 0.90–1.14). In fact, patients with sepsis had slightly lower risk of diagnostic error when there were gaps in history-taking or referrals, though no other interactions were statistically significant.<br /><br />The main conclusion was that, despite diagnostic errors being common in sepsis patients with poor outcomes, sepsis itself did not increase diagnostic error risk. The authors suggest this may be due to the protocol-driven nature of sepsis care. They also note that broader challenges in the diagnostic process may contribute more to errors than sepsis-specific factors alone. Further research is needed, especially in less severe sepsis cases and to test whether sepsis-specific alerts or response teams could improve outcomes.

Asset Subtitle

Priya A. Prasad

Meta Tag

Author List Alyssa Harris, Andrew D. Auerbach, Anuj Dalal, Colin Hubbard, Ellen Flynn, Gilmer Valdes, Jeffrey L. Schnipper, John Boscardin, Katie E. Raffel, Priya A. Prasad, Sumant Ranji, Tiffany M. Lee

Category Research

Concept Sepsis

Concept Diagnostic Error

Concept Diagnostic Process Fault

Concept Hospitalized Patient

Concept History Taking

Distinguished Non-Finalist

Presenter Organization University of California San Francisco

Presenting Author Priya A. Prasad

Track Patient Safety

Keywords

sepsis

diagnostic error

hospitalized patients

UPSIDE study

multicenter analysis

diagnostic process faults

ICU transfer

mortality

adjusted risk ratio

protocol-driven care

Sepsis

Diagnostic Error

Diagnostic Process Fault

Hospitalized Patient

History Taking