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

Simon Peter Katongole,1 Patricia Akweongo,2 Robert Anguyo,3 Daniel Evans Kasozi,4 Augustine Adomah-Afari2 1Simon Peter Katongole, School of Public Health, Gudie University Project, Kampala, Uganda; 2Department of Health Policy, Planning and Management, University of Ghana, Accra, Ghana; 3Monitoring, Evaluation, Technical Assistance and Research (METRe) Group; Department of International Public Health, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK; 4The United States Agency for International Development, US Embassy Kampala, Kampala, UgandaCorrespondence: Simon Peter Katongole, Gudie University Project, P.O. Box 27450, Kampala, Uganda, Tel +256 702 830 019, Email spkatongole@gmail.comPurpose: 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