{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T11:18:53Z","timestamp":1789471133111,"version":"build-2803163510"},"reference-count":36,"publisher":"BMJ","issue":"5","funder":[{"name":"CRICO\/RMF","award":["no award\/grant number"],"award-info":[{"award-number":["no award\/grant number"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2022,9,16]]},"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To evaluate rates, risk factors and outcomes of delayed diagnosis of seven serious paediatric conditions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a retrospective, cross-sectional study of children under 21 years old visiting 13 community and tertiary emergency departments (EDs) with appendicitis, bacterial meningitis, intussusception, mastoiditis, ovarian torsion, sepsis or testicular torsion. Delayed diagnosis was defined as having a previous ED encounter within 1\u2009week in which the condition was present per case review. Patients with delayed diagnosis were each matched to four control patients without delay by condition, facility and age. Conditional logistic regression models evaluated risk factors of delay. Complications were compared between by delayed diagnosis status.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 14\u2009972 children, delayed diagnosis occurred in 1.1% (range 0.3% for sepsis to 2.6% for ovarian torsion). Hispanic (matched OR 2.71, 95%\u2009CI 1.69 to 4.35) and non-Hispanic black (OR 2.40, 95%\u2009CI 1.21 to 4.79) race\/ethnicity were associated with delayed diagnosis, whereas Asian and other race\/ethnicity were not. Public (OR 2.21, 95%\u2009CI 1.42 to 3.44) and other (OR 2.43, 95%\u2009CI 1.50 to 3.93) insurance were also associated with delay. Non-English language was associated with delay (OR 1.65, 95%\u2009CI 1.02 to 2.69). Abnormal vital signs were associated with a lower likelihood of delay (OR 0.15, 95%\u2009CI 0.09 to 0.25). In an adjusted model, Hispanic race\/ethnicity, other insurance, abnormal vital signs and complex chronic conditions (CCCs) were associated with delay. The odds of a complication were 2.5-fold (95%\u2009CI 1.6 to 3.8) higher among patients with a delay.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Delayed diagnosis was uncommon across 13 regional EDs but was more likely among children with Hispanic ethnicity, CCCs or normal vital signs. Delays were associated with a higher risk of complications.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjqs-2022-015314","type":"journal-article","created":{"date-parts":[[2022,9,30]],"date-time":"2022-09-30T13:21:09Z","timestamp":1664544069000},"page":"293-300","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Delayed diagnosis of serious paediatric conditions in 13 regional emergency departments"],"prefix":"10.1136","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1763-7262","authenticated-orcid":false,"given":"Kenneth A","family":"Michelson","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA"},{"name":"Department of Pediatrics, South Shore Hospital, Weymouth, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Finn L E","family":"McGarghan","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma E","family":"Patterson","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret E","family":"Samuels-Kalow","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark L","family":"Waltzman","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA"},{"name":"Department of Pediatrics, South Shore Hospital, Weymouth, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly F","family":"Greco","sequence":"additional","affiliation":[{"name":"Institutional Centers for Clinical and Translational Research, Boston Children\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,9,30]]},"reference":[{"key":"2025090410363370000_33.5.293.1","doi-asserted-by":"crossref","unstructured":"Balogh EP , Miller BT , Ball JR . 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