Missed Diagnoses and Adverse Outcomes in Older Adults Socially Admitted to the Hospital After Low-Energy Trauma

OBJECTIVES: To assess the frequency of missed diagnoses and their association with mortality and care escalation among older adults socially admitted to hospital after low-energy trauma. DESIGN: Single-center observational cohort study. SETTING AND PARTICIPANTS: Patients aged ≥65 years who were socially admitted via the emergency department after low-energy trauma. Patients with major injuries or clear medical indications for admission were excluded. METHODS: A missed diagnosis was defined as a clinically relevant condition not identified during initial emergency department assessment but diagnosed after admission and requiring therapeutic intervention. The primary outcome was 180-day all-cause mortality. The secondary outcome was escalation of care needs at discharge. Survival was analyzed using Kaplan-Meier curves and Cox proportional hazards regression, with adjustment for frailty and comorbidity. RESULTS: ; 95% CI, 0.81-0.97). CONCLUSIONS AND IMPLICATIONS: Among older adults socially admitted after low-energy trauma, missed diagnoses are common and independently associated with short-term mortality. These findings suggest that social admission may reflect diagnostic vulnerability rather than low clinical risk. For clinical practice, early diagnostic vigilance and structured geriatric assessment during emergency care may be warranted in this population. Future prospective studies are needed to evaluate whether systematic diagnostic strategies can improve outcomes.