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Overdiagnosis of urinary tract infection linked to overdiagnosis of pneumonia: a multihospital cohort study
  1. Ashwin Gupta1,2,
  2. Lindsay Petty3,
  3. Tejal Gandhi3,
  4. Scott Flanders2,
  5. Lama Hsaiky4,
  6. Tanima Basu2,
  7. Qisu Zhang2,
  8. Jennifer Horowitz2,
  9. Zainab Masood2,
  10. Vineet Chopra2,
  11. Valerie M Vaughn2,5,6
  1. 1Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  2. 2Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  3. 3Division of Infectious Diseases, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  4. 4Department of Pharmacy, Beaumont Hospital, Dearborn, Michigan, USA
  5. 5Division of General Internal Medicine, The University of Utah School of Medicine, Salt Lake City, Utah, USA
  6. 6Department of Population Health Science, The University of Utah School of Medicine, Salt Lake City, Utah, USA
  1. Correspondence to Dr Ashwin Gupta, Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA; ashwing{at}med.umich.edu

Abstract

Urinary tract infection (UTI) and community-acquired pneumonia (CAP) are the most common infections treated in hospitals. UTI and CAP are also commonly overdiagnosed, resulting in unnecessary antibiotic use and diagnostic delays. While much is known individually about overdiagnosis of UTI and CAP, it is not known whether hospitals with higher overdiagnosis of one also have higher overdiagnosis of the other. Correlation of overdiagnosis of these two conditions may indicate underlying hospital-level contributors, which in turn may represent targets for intervention. To evaluate the association of overdiagnosis of UTI and CAP, we first determined the proportion of hospitalised patients treated for CAP or UTI at 46 hospitals in Michigan who were overdiagnosed according to national guideline definitions. Then, we used Pearson’s correlation coefficient to compare hospital proportions of overdiagnosis of CAP and UTI. Finally, we assessed for ‘diagnostic momentum’ (ie, accepting a previous diagnosis without sufficient scepticism) by determining how often overdiagnosed patients remained on antibiotics on day 3 of hospitalisation. We included 14 085 patients treated for CAP (11.4% were overdiagnosed) and 10 398 patients treated for UTI (27.8% were overdiagnosed) across 46 hospitals. Within hospitals, the proportion of patients overdiagnosed with UTI was moderately correlated with the proportion of patients overdiagnosed with CAP (r=0.53, p<0.001). Over 80% (81.8% (n=952/1164) of UTI; 89.9% (n=796/885) of CAP) of overdiagnosed patients started on antibiotics by an emergency medicine clinician remained on antibiotics on day 3 of hospitalisation. In conclusion, we found overdiagnosis of UTI and CAP to be correlated at the hospital level. Reducing overdiagnosis of these two common infections may benefit from systematic interventions.

  • diagnostic errors
  • hospital medicine
  • health services research
  • patient safety

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Footnotes

  • Twitter @ashwin_b_gupta, @ValerieVaughnMD

  • Contributors AG and VMV devised the project. AG wrote the manuscript, to which all authors provided critical feedback. LP, TG, SF, LH, VC and TB contributed towards study design and data interpretation. TB and QZ were the primary data analysts for this project. JH and ZM served as project managers and contributed to drafting both the initial manuscript and the revisions.

  • Funding This study was funded by the Gordon and Betty Moore Foundation.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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