UI study surveys infectious disease specialists network, gets ‘Freakonomics’ attention

Diagnostic delays are a major contributor to infectious disease-related morbidity and mortality. However, little is known about the underlying causes of these delays. Manish Suneja, MD, and a team of UI Internal Medicine researchers recently took on the challenge and identified two common contributors: not initially considering diagnosis and not ordering appropriate tests. In addition to publishing their findings in Diagnosis, the study was featured and cited on a recent episode of the popular podcast Freakonomics, M.D. A transcript of the episode is also available at the link.

Through surveying members of the Emerging Infections Network (EIN), the study aimed to understand the relative frequency and contributing factors of diagnostic delays for six infectious diseases, including tuberculosis, non-tuberculosis mycobacterial infections, syphilis, epidural abscess, infective endocarditis, and endemical fungal infections. The 25-item survey asked for voluntary participation through the EIN’s listserv, a sentinel network with thousands of members.

Manish Suneja, MD, clinical professor in Nephrology; Susan Beekmann, RN, MPH; Aaron C. Miller, PhD, research assistant professor of Infectious Diseases; and Philip M. Polgreen, MD, MPH, professor of Infectious Diseases, are four of the study’s authors. Polgreen serves as the director of the network, and Beekmann as the program coordinator. The fifth author, Gurpreet Dhaliwal, MD, professor of Medicine at the University of California San Francisco, was interviewed on Freakonomics, M.D., describing some of the ways in which a diagnosis can take a wrong turn and what their study found.

“Results from this study highlight several different infectious diseases for which diagnostic delays commonly occur,” Suneja said. “The results from this study pave the way for potential directions for future interventions to decrease diagnostic delays.”

Funded by the Centers for Disease Control and Prevention (CDC), the EIN is a part of the Infectious Disease Society of America and headquartered at the University of Iowa. “The EIN is a flexible sentinel network of more than 3,000 infectious disease providers and additional public health members from federal, state and local public health departments,” Beekmann said. “The EIN is tasked with assisting CDC and other public health authorities with surveillance for emerging infectious diseases and related phenomena.”

A total of 533 EIN physicians responded to the team’s survey. They also found that unusual clinical presentations and delayed consultation with infectious disease physicians contributed to delayed diagnosis. The study found that test errors, including ordering the wrong test, laboratory delays, and lab processing delays also led to diagnosis delays.