Factors associated with misdiagnosis of hospitalized patients in general hospitals of Central Uganda

Misdiagnosis of inpatients is a major public health issue whose scope and causes are unknown in Sub-Saharan African countries. The purpose of this cross-sectional study, which was conducted in five hospitals in central Uganda, was to identify the factors associated with inpatient misdiagnosis in general hospitals in Central Uganda. Records of 2,431 patients admitted between July 1st, 2019 and June 30th, 2020 were specifically reviewed to obtain data on variables thought to be associated with misdiagnosis. The admission diagnosis assigned at the emergency or outpatient department was compared to the discharge diagnosis assigned immediately after the patient's admission, with any difference considered a misdiagnosis. The disease, patient, health system, and environmental factors associated with misdiagnosis were identified using multivariable logistic regression analysis. Misdiagnosis was found in the records of 223/2431 (9.2%) of the admitted patients. A patient admitted to Nakaseke hospital [aOR=1.95, 95% CI=1.17-3.25, p=0.01], being admitted at night [aOR=3, 95% CI=1.81-5.02, p0.01], male patient [aOR=1.89, 95% CI=1.35-2.64, p0.01], patient's age groups 10-19 [AOR=2.3, 95% CI=2.3-9.25, p0.01]; 20-29 [AOR=8.15, 95% CI=4.18-15.89], p<0.01; 30-39; and 40-49;; AOR=8.12, 95% CI=3.99-16.54, p<0.01; AOR=7.88, 95% CI=3.71-16.73, p<0.01; and AOR=12.14, 95% CI=6.41-23.01, p<0.0]. Misdiagnosis was also associated with multimorbidity (aOR=4.71, 95% CI=1.91-11.65, p0.01) and patients treated for uncommon diseases (aOR=2.57, 95% CI=1.28-5.18, p0.01). Patients without underlying diseases [aOR=0.63; 95% CI=0.43-0.91, p=0.015] and those who were not referred [aOR=0.51; 95% CI=0.31-0.86, p=0] .011] were less likely to be related to misdiagnosis. To improve diagnostic accuracy, hospitals should reorganize patient admission processes, conducted targeted training, develop policy or guidelines targeting factors predisposing to misdiagnosis, and the adopt a diagnostic error prevention culture. ### Competing Interest Statement The authors declare that this study is part of a PhD thesis of the lead author at the Department of Health Policy, Planning and Management, University of Ghana, Legon. Consequently, two other manuscripts have been submitted elsewhere for consideration for publication. These are titled ? Simon Peter Katongole, Patricia Akweongo, Robert Anguyo Onzima, Daniel Evans Kasozi, Augustine Adoma Afari, (2022). Prevalence and classification of misdiagnosis among hospitalised patients in five general hospitals of Central Uganda. Clinical Audit, (in-press accepted for publication). ? Simon Peter Katongole, Patricia Akweongo, Robert Anguyo DDMO, Daniel Evans Kasozi, Augustine Adoma Afari. An explanatory inquiry of the health system, disease, patient, and contextual factors contributing to misdiagnosis of hospitalized patients in five general hospitals in Central Uganda (2022), (submitted to PLOS ONE)