Diagnosis Documentation of Critically Ill Children at Admission to a PICU*

Vivtcharenko, Victoria; Ramesh, Sonali; Dukes, Kimberly; Singh, Hardeep; Herwaldt, Loreen A.; Reisinger, Heather Schacht; Cifra, Christina L.

doi:10.1097/pcc.0000000000002812

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…Vivtcharenko VY, Ramesh S, Dukes KC, et al: Diagnosis Documentation of Critically Ill Children at Admission to a PICU (4).…”

Section: What Is the Extent Of Diagnostic Uncertainty And Documentati...mentioning

confidence: 99%

Editor’s Choice Articles for February

Tasker¹

2022

Pediatric Critical Care Medicine

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F ebruary 2022 and the Society of Critical Care Medicine (SCCM) Annual Congress issue of Pediatric Critical Care Medicine (PCCM). So much important content: six Feature articles, a Special Article, an SCCM Clinical Practice Guideline, and more besides these. There are also six accompanying editorials that give contemporary expert perspectives. All-in-all, a remarkable issue worthy of this year's SCCM conference. Now, I have the difficult task of first drawing your attention to just three Editor's Choices articles.

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“…Vivtcharenko VY, Ramesh S, Dukes KC, et al: Diagnosis Documentation of Critically Ill Children at Admission to a PICU (4).…”

Section: What Is the Extent Of Diagnostic Uncertainty And Documentati...mentioning

confidence: 99%

Editor’s Choice Articles for February

Tasker¹

2022

Pediatric Critical Care Medicine

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“…The study by Vivtcharenko et al (10) adds to the body of literature highlighting suboptimal documentation practices. However, in order to move forward in understanding the true implications of this issue, what is needed are more studies that investigate how diagnosis documentation affects medical decision-making, patient care, and outcomes.…”

mentioning

confidence: 99%

“…In this issue of Pediatric Critical Care Medicine , Vivtcharenko et al (10) examined diagnosis documentation in 100 admission notes for children (0–17 yr) admitted to a single PICU over 1 year. The study sought to describe the type of information clinicians include with diagnoses and to explain how clinicians interpret and integrate clinical information to create a narrative around diagnoses.…”

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confidence: 99%

The Lost Art of Documentation*

Sanderson¹

2022

Pediatric Critical Care Medicine

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T hanks to improvements in operative and perioperative care of patients with congenital heart disease (CHD) over the previous decades, survival is the expected outcome for almost all children undergoing congenital heart surgery (1). Given the relative rarity of mortality for most surgical procedures, challenges exist in defining metrics that are both meaningful to our patients and their families and illuminate opportunities to optimize

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Diagnostic Uncertainty Among Critically Ill Children Admitted to the PICU: A Multicenter Study

Cifra,

Custer,

Smith

et al. 2024

Critical Care Medicine

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Objectives: This study aimed to identify the prevalence of and factors associated with diagnostic uncertainty when critically ill children are admitted to the PICU. Understanding diagnostic uncertainty is necessary to develop effective strategies to reduce diagnostic errors in the PICU. Design: Multicenter retrospective cohort study with structured medical record review by trained clinicians using a standardized instrument to identify diagnostic uncertainty in narrative clinical notes. Diagnoses and diagnostic uncertainty were compared across time from PICU admission to hospital discharge. Generalized linear mixed models were used to determine patient, clinician, and encounter characteristics associated with diagnostic uncertainty at PICU admission. Setting: Four academic tertiary-referral PICUs. Patients: Eight hundred eighty-two randomly selected patients 0–18 years old who were nonelectively admitted to participating PICUs. Interventions: None. Measurements and Main Results: PICU admission notes for 228 of 882 patients (25.9%) indicated diagnostic uncertainty. Patients with uncertainty decreased over time but 58 (6.6%) had remaining diagnostic uncertainty at hospital discharge. Multivariable analysis showed that diagnostic uncertainty was significantly associated with off hours admission (odds ratio [OR], 1.52; p = 0.037), greater severity of illness (OR, 1.04; p = 0.025), an atypical presentation (OR, 2.14; p = 0.046), diagnostic discordance at admission between attending intensivists and resident physicians/advanced practice providers (OR, 3.62; p < 0.001), and having a neurologic primary diagnosis (OR, 1.87; p = 0.03). Older patients (OR, 0.96; p = 0.014) and those with a respiratory (OR, 0.58; p = 0.009) or trauma primary diagnosis (OR, 0.08; p < 0.001) were less likely to have diagnostic uncertainty. There were no significant associations between diagnostic uncertainty and attending intensivists’ characteristics. Conclusions: Diagnostic uncertainty at PICU admission was common and was associated with off hours admission, severe illness, atypical presentation, diagnostic discordance between clinicians, and a neurologic primary diagnosis. Further study on the recognition and management of diagnostic uncertainty is needed to inform interventions to improve diagnosis among critically ill children.

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Diagnosis Documentation of Critically Ill Children at Admission to a PICU*

Cited by 3 publications

References 15 publications

Editor’s Choice Articles for February

Editor’s Choice Articles for February

The Lost Art of Documentation*

Diagnostic Uncertainty Among Critically Ill Children Admitted to the PICU: A Multicenter Study

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