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Abstract：
The purpose of this paper was to investigate patterns of health care utilization leading up to diagnosis of necrotizing soft tissue infections of the genitalia and to identify risk factors associated with potential diagnostic delay.
IBM MarketScan Research Databases (2001-2020) were used to identify index cases of necrotizing soft tissue infections of the genitalia. We identified health care visits for symptomatically similar diagnoses (eg, penile swelling, cellulitis) that occurred prior to necrotizing soft tissue infections of the genitalia diagnosis. A change-point analysis identified the window before diagnosis where diagnostic opportunities first appeared. A simulation model estimated the likelihood symptomatically similar diagnosis visits represented a missed opportunity for earlier diagnosis. Patient and provider characteristics were evaluated for their associations with delay.
We identified 8,098 patients with necrotizing soft tissue infections of the genitalia, in which 4,032 (50%) had a symptomatically similar diagnosis visit in the 21-day diagnostic window, most commonly for \"non-infectious urologic abnormalities\" (eg, genital swelling; 64%): 46% received antibiotics; 16% saw a urologist. Models estimated that 5,096 of the symptomatically similar diagnosis visits (63%) represented diagnostic delay (mean duration 6.2 days; mean missed opportunities 1.8). Risk factors for delay included urinary tract infection history (OR 2.1) and morbid obesity (OR 1.6). Visits to more than 1 health care provider/location in a 24-hour period significantly decreased delay risk.
Nearly 50% of insured patients who undergo debridement for, or die from, necrotizing soft tissue infections of the genitalia will present to a medical provider with a symptomatically similar diagnosis suggestive of early disease development. Many of these visits likely represent diagnostic delay. Efforts to minimize logistic and cognitive biases in this rare condition may lead to improved outcomes if they lead to earlier interventions.
IBM MarketScan Research Databases (2001-2020) were used to identify index cases of necrotizing soft tissue infections of the genitalia. We identified health care visits for symptomatically similar diagnoses (eg, penile swelling, cellulitis) that occurred prior to necrotizing soft tissue infections of the genitalia diagnosis. A change-point analysis identified the window before diagnosis where diagnostic opportunities first appeared. A simulation model estimated the likelihood symptomatically similar diagnosis visits represented a missed opportunity for earlier diagnosis. Patient and provider characteristics were evaluated for their associations with delay.
We identified 8,098 patients with necrotizing soft tissue infections of the genitalia, in which 4,032 (50%) had a symptomatically similar diagnosis visit in the 21-day diagnostic window, most commonly for \"non-infectious urologic abnormalities\" (eg, genital swelling; 64%): 46% received antibiotics; 16% saw a urologist. Models estimated that 5,096 of the symptomatically similar diagnosis visits (63%) represented diagnostic delay (mean duration 6.2 days; mean missed opportunities 1.8). Risk factors for delay included urinary tract infection history (OR 2.1) and morbid obesity (OR 1.6). Visits to more than 1 health care provider/location in a 24-hour period significantly decreased delay risk.
Nearly 50% of insured patients who undergo debridement for, or die from, necrotizing soft tissue infections of the genitalia will present to a medical provider with a symptomatically similar diagnosis suggestive of early disease development. Many of these visits likely represent diagnostic delay. Efforts to minimize logistic and cognitive biases in this rare condition may lead to improved outcomes if they lead to earlier interventions.
摘要：
目的：本文的目的是调查导致诊断生殖器坏死性软组织感染的医疗保健利用模式，并确定与潜在诊断延迟相关的危险因素。
方法：使用TruvenHealthAnalytics商业索赔数据库（2001-2020）来确定生殖器坏死性软组织感染的索引病例。我们确定了对症状相似诊断的医疗保健访问(例如，阴茎肿胀,蜂窝织炎）发生在生殖器诊断的坏死性软组织感染之前。变化点分析确定了诊断前首次出现诊断机会的窗口。模拟模型估计了似然相似的诊断访问表示错过了早期诊断的机会。评估患者和提供者特征与延迟的关联。
结果：我们确定了8,098例生殖器坏死性软组织感染患者，其中4,032（50％）在21天的诊断窗口中进行了症状相似的诊断访问，最常见于“非感染性泌尿系统异常”(例如，生殖器肿胀；64％）：46％接受了抗生素治疗；16％的人看到了泌尿科医生。模型估计，5,096次症状相似的诊断访问（63％）代表诊断延迟（平均持续时间6.2天；平均错失机会1.8）。延迟的危险因素包括尿路感染史（OR2.1）和病态肥胖（OR1.6）。在24小时内访问超过1个医疗保健提供者/地点显着降低了延迟风险。
结论：近50%的参保患者接受清创治疗，或死于，生殖器的坏死性软组织感染将呈现给医疗提供者，其症状相似，提示疾病早期发展。这些访问中的许多可能代表诊断延迟。在这种罕见的情况下，尽量减少后勤和认知偏见的努力可能会导致改善的结果，如果它们导致更早的干预措施。
方法：使用TruvenHealthAnalytics商业索赔数据库（2001-2020）来确定生殖器坏死性软组织感染的索引病例。我们确定了对症状相似诊断的医疗保健访问(例如，阴茎肿胀,蜂窝织炎）发生在生殖器诊断的坏死性软组织感染之前。变化点分析确定了诊断前首次出现诊断机会的窗口。模拟模型估计了似然相似的诊断访问表示错过了早期诊断的机会。评估患者和提供者特征与延迟的关联。
结果：我们确定了8,098例生殖器坏死性软组织感染患者，其中4,032（50％）在21天的诊断窗口中进行了症状相似的诊断访问，最常见于“非感染性泌尿系统异常”(例如，生殖器肿胀；64％）：46％接受了抗生素治疗；16％的人看到了泌尿科医生。模型估计，5,096次症状相似的诊断访问（63％）代表诊断延迟（平均持续时间6.2天；平均错失机会1.8）。延迟的危险因素包括尿路感染史（OR2.1）和病态肥胖（OR1.6）。在24小时内访问超过1个医疗保健提供者/地点显着降低了延迟风险。
结论：近50%的参保患者接受清创治疗，或死于，生殖器的坏死性软组织感染将呈现给医疗提供者，其症状相似，提示疾病早期发展。这些访问中的许多可能代表诊断延迟。在这种罕见的情况下，尽量减少后勤和认知偏见的努力可能会导致改善的结果，如果它们导致更早的干预措施。
