Diagnostic delays in infectious diseases
Diagnostic delays in infectious diseases
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DOI：
10.1515/dx-2021-0092
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发表时间：
2022-01-20
期刊：
影响因子：
3.5
通讯作者：
Polgreen, Philip M.
中科院分区：
文献类型：
--
作者：
Suneja, Manish;Beekmann, Susan E.;Polgreen, Philip M.
目的：诊断延误是发病率和死亡率的主要来源。尽管与诊断延迟相关的不良后果，很少有研究调查了不同传染病的发病率和影响诊断延迟的因素。本研究的目的是了解传染病（ID）顾问常见的六种传染病诊断延误的相对频率，并检查这些延误的影响因素。方法：向新发感染网络（EIN）中为成人患者提供护理的所有传染病医生发送一份25项调查，以检查6种传染病的诊断延误。疾病包括：(1)结核病，(2)非结核性分枝杆菌感染，(3)梅毒，(4)硬膜外脓肿，(5)感染性心内膜炎，(6)地方性真菌感染（如组织浆菌病、芽生菌病）。结果：在1323名EIN成员中，共有533名（40%）回应了调查。应答者认为最初没有考虑诊断和没有订购适当的测试是导致诊断延误的两个最重要的因素。据报道，不寻常的临床表现和没有尽早咨询ID医生也是导致延误的因素。在开放文本字段中记录的响应也表明，与测试相关的错误可能导致延迟；具体来说，与测试相关的错误包括订购错误的实验室测试、实验室延迟（设施中没有专门的实验室）和实验室处理延迟。结论：我们所考虑的传染病的诊断延迟是常见的。我们确定的影响因素是未来干预减少诊断延误的潜在目标。
Objectives: Diagnostic delays are a major source of morbidity and mortality. Despite the adverse outcomes associated with diagnostic delays, few studies have examined the incidence and factors that influence diagnostic delays for different infectious diseases. The objective of this study was to understand the relative frequency of diagnostic delays for six infectious diseases commonly seen by infectious diseases (ID) consultants and to examine contributing factors for these delays.Methods: A 25-item survey to examine diagnostic delays in six infectious diseases was sent to all infectious diseases physicians in the Emerging Infections Network (EIN) who provide care to adult patients. Diseases included (1) tuberculosis, (2) non-tuberculous mycobacterial infections, (3) syphilis, (4) epidural abscess, (5) infective endocarditis, and (6) endemic fungal infections (e.g., histoplasmosis, blastomycosis).Results: A total of 533 of 1,323 (40%) EIN members responded to the survey. Respondents perceived the diagnosis not being considered initially and the appropriate test not being ordered as the two most important contributors to diagnostic delays. Unusual clinical presentations and not consulting ID physicians early enough were also reported as a contributing factor to delays. Responses recorded in open-text fields also indicated errors related to testing as a likely cause of delays; specifically, test-related errors included ordering the wrong laboratory test, laboratory delays (specialized labs not available at the facility), and lab processing delays.Conclusions: Diagnostic delays commonly occur for the infectious diseases we considered. The contributing factors we identified are potential targets for future interventions to decrease diagnostic delays.