A comparison of emergency department admission diagnoses and discharge diagnoses: retrospective study

Objective: To study the accuracy of emergency department admission diagnosis and the effect of investigations on diagnostic accuracy. Design: Retrospective study in a two-month period. Setting: Accident & Emergency Department of a public general hospital, which had four in-patient specialties – Medicine, Surgery, Paediatrics and Orthopaedics. Subjects: All cases admitted through the emergency department in the study period. Main outcome measures: Degree of correlation between emergency department admission diagnosis and hospital discharge diagnosis. Results: Of all admission diagnoses, 71.4% fully or partially matched the final discharge diagnoses. The accuracy of diagnosis was statistically better in traumatic cases, the male sex and young adults. Diagnostic accuracy varied with the specialty involved and investigations taken. Conclusion: History and physical examination remained the most important diagnostic tools in the emergency department. In general, simple investigations available at the emergency department were not helpful in improving diagnostic accuracy. (Hong Kong j.emerg.med. 2003;10:70-75)