Prevalence and Classification of Misdiagnosis Among Hospitalised Patients in Five General Hospitals of Central Uganda

Abstract

Purpose

This study sought to determine the magnitude of patients’ misdiagnosis, classify the extent to which patients were misdiagnosed, determine the major diagnostic groupings and the topmost misdiagnosed diseases 11th version of the International Classification of Diseases (ICD-11).

Methods

We conducted a retrospective review of 2431 patients’ records. A patient was adjudged to have been misdiagnosed if there was a difference between the initial diagnosis and the final diagnoses which had been collectively and collaboratively agreed upon review on admission. Misdiagnosis was classified as Class I, Class II, Class III and Class IV. The Pareto analysis was used to determine the topmost misdiagnosed diseases and ICD-11 major diagnostic groupings. We established the three leading misdiagnosed diseases for each of the topmost ICD-11 major diagnostic groupings.

Results

The results indicate that 9.2% (223/2341) of the inpatients were initially misdiagnosed. There were 303 conditions involved in the misdiagnosis. The majority, 70.9% (158/223) of the misdiagnosed patients were classified as Class I. The ICD-11 major diagnostic groupings accounted for at least 80% of the misdiagnosis were certain infectious or parasitic diseases (32%), diseases of the digestive system (12%), diseases of the circulatory system (11%), endocrine, nutritional or metabolic disorders (9%), diseases of the respiratory system (7%), diseases of the genitourinary system 20/303 (7%), and diseases of blood and blood forming organs (5%). The 19 topmost misdiagnosed diseases or conditions included; peptic ulcer disease, severe malaria, hypertension, gastroenteritis, pneumonia, urinary tract infection, enteric fever, tuberculosis, septicemia, bacteremia, anaemia, congestive cardiac failure, diabetes mellitus, stroke, chronic obstructive pulmonary disease, respiratory tract infection, cystitis, cryptococcal meningitis, epilepsy and gastritis.

Conclusion

Efforts to improve patient diagnosis should focus on the “vital few” topmost misdiagnosed conditions and ICD-11 major diagnostic groupings that account for at least 80% of the burden of the misdiagnosis.

Keywords:

• prevalence
• classification
• misdiagnosis
• general hospitals

Abbreviations

OPD, outpatient department; ED, emergency department; HMIS, health management information system; ICD-11, international classification of diseases eleventh version.

Data Sharing Statement

The data for this study are available upon written request through the corresponding author as long as the request for data complies with the guideline of the Ethics Review Board.

Consent for Publication

All authors consented to having this work published.

Acknowledgments

The authors acknowledge the medical superintendents and staff of all the participating hospitals where this study was conducted. This study is part of a PhD thesis of SPK, the lead author who is a student at the Department of Health Policy, Planning and Management, University of Ghana, Legon.

Author Contributions

All authors significantly contributed to this work, whether it be in the conception, study design, implementation, data collection, analysis, and interpretation. They also participated in writing, revising, or critically evaluating the article, gave their final approval for the version that would be published, decided on the journal to which the article would be submitted, and agree to be responsible for all aspects of the work.

Disclosure

The authors report no competing interests in this work.