Factors associated with misdiagnosis of hospitalised patients in general hospitals of Central Uganda

Abstract

AbstractMisdiagnosis of inpatients is a major public health issue whose scope and causes are unknown in Sub-Saharan African countries. The purpose of this cross-sectional study, which was conducted in five hospitals in central Uganda, was to identify the factors associated with inpatient misdiagnosis in general hospitals in Central Uganda. Records of 2,431 patients admitted between July 1st, 2019 and June 30th, 2020 were specifically reviewed to obtain data on variables thought to be associated with misdiagnosis. The admission diagnosis assigned at the emergency or outpatient department was compared to the discharge diagnosis assigned immediately after the patient’s admission, with any difference considered a misdiagnosis. The disease, patient, health system, and environmental factors associated with misdiagnosis were identified using multivariable logistic regression analysis.Misdiagnosis was found in the records of 223/2431 (9.2%) of the admitted patients. A patient admitted to Nakaseke hospital [aOR=1.95, 95% CI=1.17-3.25, p=0.01], being admitted at night [aOR=3, 95% CI=1.81-5.02, p0.01], male patient [aOR=1.89, 95% CI=1.35-2.64, p0.01], patient’s age groups 10-19 [AOR=2.3, 95% CI=2.3-9.25, p0.01]; 20-29 [AOR=8.15, 95% CI=4.18-15.89], p<0.01; 30-39; and 40-49;; AOR=8.12, 95% CI=3.99-16.54, p<0.01; AOR=7.88, 95% CI=3.71-16.73, p<0.01; and AOR=12.14, 95% CI=6.41-23.01, p<0.0]. Misdiagnosis was also associated with multimorbidity (aOR=4.71, 95% CI=1.91-11.65, p0.01) and patients treated for uncommon diseases (aOR=2.57, 95% CI=1.28-5.18, p0.01). Patients without underlying diseases [aOR=0.63; 95% CI=0.43-0.91, p=0.015] and those who were not referred [aOR=0.51; 95% CI=0.31-0.86, p=0] .011] were less likely to be related to misdiagnosis.To improve diagnostic accuracy, hospitals should reorganize patient admission processes, conducted targeted training, develop policy or guidelines targeting factors predisposing to misdiagnosis, and the adopt a diagnostic error prevention culture.