The purpose of this study was to ( a) determine the frequency of diagnostic errors in pediatric cancer, ( b) categorize errors, and ( c) underscore themes associated with misdiagnosis. This is a retrospective cohort study at a tertiary children's hospital of 265 patients with new oncologic diagnoses. The diagnostic error rate was 28%. Compared with those with no diagnostic error, those in whom there was an error were more likely to have ( a) more visits before diagnosis ( P < .001), ( b) not been seen in an acute care setting ( P = .03), ( c) inappropriate treatment ( P < .001), and ( d) misinterpreted laboratory studies or imaging ( P < .001). Themes in diagnostic errors were lack of appropriate evaluation for persistent symptoms (47%), failure to recognize signs and symptoms suggestive of malignancy (45%), and misinterpretation of tests (8%). Clinicians should consider diagnostic evaluation for multiple visits for the same complaint or a constellation of signs and symptoms suggestive of malignancy.

Institutions vary in their requirements for determining competency and granting privileges for providing moderate and deep procedural sedation. Several specialties outside of anesthesiology routinely provide pediatric procedural sedation services. Attaining sedation competency requires a multitiered approach to education, training, and assessment that encompasses factual knowledge and higher-level cognitive functioning such as clinical decision-making, communication skills, psychomotor skills, and ability to function as a member of a multidisciplinary team. Educational and training methods used to teach procedural sedation include written materials, didactic lectures, interactive small-group sessions, medical simulation, and clinical experience with mentoring. Assessment of procedural sedation knowledge and skills includes written examinations, medical simulation, proctoring, and multisource evaluations.