International Journal of Infectious Diseases · Published 2026-07-01 · DOI 10.1016/j.ijid.2026.109003
Yara M.W. van Knippenberg, Konstantin Föhse, Charlotte C.M. Schaap, Mihai G. Netea, Jacobien Hoogerwerf, Jaap ten Oever
Background: Establishing an accurate presumptive diagnosis in the emergency department (ED) is challenging in patients with suspected infection. Diagnostic discordance between the presumptive ED diagnosis and the adjudicated discharge diagnosis is common and may result in both over- and undertreatment. While age and comorbidity have been associated with diagnostic discordance, these factors do not fully capture a patient’s physiological vulnerability. The independent association between frailty and diagnostic discordance remains underexplored. The objective of this study was to evaluate the independent association between frailty and diagnostic discordance in the ED. Methods: Retrospective analysis was conducted of adults presenting to the ED with suspected infection. Diagnostic discordance was assessed by comparing presumptive ED diagnosis with adjudicated discharge diagnoses. Determinants of discordance were analysed using multivariable regression. Results: Frailty was independently associated with diagnostic discordance (aOR 1.622, 95% CI 1.094-2.405, P = 0.016). As was a higher age-adjusted Charlson Comorbidity Index (aOR 1.105, 95% CI 1.013-1.204, P = 0.024). Higher Modified Early Warning Score showed a borderline inverse association with diagnostic discordance. Conclusion: Frailty was independently associated with diagnostic discordance in the ED. Recognition of frailty may help identify patients at increased risk of diagnostic discordance and support careful diagnostic reassessment.
Abstract from DOAJ. Public domain (CC0 1.0).
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Knippenberg, Y., Föhse, K., Schaap, C., et al. (2026). Identifying emergency department patients at risk of diagnostic discordance between the presumptive emergency department diagnosis and the adjudicated discharge diagnosis: the independent role of frailty. International Journal of Infectious Diseases. https://doi.org/10.1016/j.ijid.2026.109003