# Delayed Diagnosis of Serious Pediatric Emergency Conditions

> **NIH AHRQ K08** · BOSTON CHILDREN'S HOSPITAL · 2021 · $153,440

## Abstract

PROJECT SUMMARY
Delays in diagnosis represent a major cause of morbidity in the emergency department (ED) setting. Children
are likely at increased risk of delayed diagnosis in the ED because symptoms and signs of serious disease
may be nonspecific, and because as many as 95% of children visit EDs that primarily evaluate adults. Rates of
delayed diagnosis among children in the ED are unknown, but likely vary substantially across settings.
Because delayed diagnosis represents a major threat to patient safety, focused research is needed to
determine its incidence, risk factors, and outcomes in children visiting EDs. The major objective of this
project is to determine patient and hospital attributes that increase the risk for delayed diagnosis of
serious conditions among children visiting EDs, and to determine the differences in patient outcomes
when delayed diagnosis occurs. The project’s specific aims are (1) to refine and validate an algorithm for
accurately detecting delayed diagnosis of three representative serious conditions (appendicitis, new-onset
diabetic ketoacidosis, and sepsis) in billing claims data; (2) to determine the incidence, between-hospital
variability, and risk factors for delayed diagnosis; and (3) to determine condition-specific outcomes of delay.
Aim 1 will refine the claims detection algorithm and compare its performance with manual record review; it will
be conducted at multiple collaborating centers. Aims 2 and 3 will use the Agency for Healthcare Research and
Quality (AHRQ) Statewide ED and Inpatient Databases for multiple states to apply the algorithm to identify
delayed diagnoses. Multilevel models will be constructed to assess predictors of delay and related health and
utilization outcomes including need for surgical procedures, critical care interventions, prolonged hospital
stays, and death. This study will directly address a top AHRQ research priority, improving health care patient
safety through identification of risks, hazards, and harms. We will focus exclusively on children, an
AHRQ priority population. The results of this research will directly allow more widespread detection
and surveillance of diagnostic delays for critical high-risk conditions, and hone methods to expand to
others. This approach utilizing a claims detection method would allow the kind of monitoring of error that is a
fundamental property of a learning health system. The Principal Investigator, Dr. Kenneth Michelson, is an
early career physician-scientist with a strong clinical background in Pediatrics and Emergency Medicine. This
award will foster his development as a researcher with content expertise in diagnostic error, sophisticated
outcomes analysis using multilevel modeling, large database analytics, and implementation science. A strong
mentorship team composed of experienced biostatistical, quantitative, emergency medicine, and diagnostic
error experts support the project and foster Dr. Michelson’s career development toward independen...

## Key facts

- **NIH application ID:** 10246799
- **Project number:** 5K08HS026503-03
- **Recipient organization:** BOSTON CHILDREN'S HOSPITAL
- **Principal Investigator:** Kenneth Michelson
- **Activity code:** K08 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $153,440
- **Award type:** 5
- **Project period:** 2019-09-01 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10246799

## Citation

> US National Institutes of Health, RePORTER application 10246799, Delayed Diagnosis of Serious Pediatric Emergency Conditions (5K08HS026503-03). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10246799. Licensed CC0.

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