Abstract
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.
Funding source: Agency for Healthcare Research and Quality
Award Identifier / Grant number: 5R01HS027375
Funding source: Centers for Disease Control and Prevention
Award Identifier / Grant number: U50 CK000477
Funding source: National Center for Advancing Translational Sciences
Award Identifier / Grant number: UL1TR002537
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Research funding: This publication was supported by a cooperative agreement (U50 CK000477) funded by the Centers for Disease Control and Prevention, a grant (5R01HS027375) funded by the Agency for Healthcare Research and Quality, and a grant (UL1TR002537) funded by the National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Gurpreet Dhaliwal MD is a member of the board of directors for the Society to Improve Diagnosis in Medicine. All authors report no conflicts of interest relevant to this article.
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Informed consent: Not applicable.
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Ethical approval: The local Institutional Review Board deemed the study exempt from review.
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