Diagnostic discrepancies in clinical practice

Issa, Victor Sarli; Dinardi, Layara Fernanda Lipari; Pereira, Thales; Almeida, Lana Carneiro; Barbosa, Thaisa Silveira; Benvenutti, Luiz Alberto; Ayub‐Ferreira, Silvia Moreira; Bocchi, Edimar Alcides

doi:10.1097/md.0000000000005978

Cited by 18 publications

(8 citation statements)

References 27 publications

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“…Second, the present study only analyzed diagnostic errors underlying medical disputes. The rate of diagnostic errors was significantly higher than previous reports [8, 17, 26]. One explanation was that there was a selection bias since only medically disputed cases were included.…”

Section: Discussioncontrasting

confidence: 56%

Diagnostic errors in fatal medical malpractice cases in Shanghai, China: 1990–2015

Gao

Zhao

et al. 2019

Diagn Pathol

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BackgroundMedical disputes remain unabated in China. Previous studies have shown the changes of diagnostic discrepancy over time in developed countries, but diagnostic discrepancy remains understudied in China, especially in the setting of medical disputes. We sought to describe the year-based changes of diagnostic discrepancies in medical disputes, and to identify factors associated with classes of diagnostic discrepancy.MethodsWe conducted a retrospective cohort study of all medically disputed cases from 1990 through 2015 in Shanghai, China, with use of necropsy as the gold standard for diagnosis. Cases were grouped based on national legislative eras. Diagnostic discrepancy was classified as major errors (class I and II), minor errors (class III and IV), no discrepancy (class V) and undetermined (class VI) based on discrepancy severity.ResultsThere were 482 medical disputes. Cases were predominantly males (male: female = 1.6:1) and concentrated in patients less than 10 years old or between 50 and 70 years. Major and minor discrepancy accounted for 51.7 and 34.8%, respectively. Fifty-five cases (11.2%) were non-discrepant (Class V). The dispute rate remained high before the first round of legislation (mean 0.31 per 1 million patients) but declined dramatically afterwards (R2 = − 0.82, p < 0.001 for time trends). Over the national legislative eras, the annual number of cases with diagnostic errors declined steadily. Incidence rates of discrepancy decreased significantly for class I (R2 = − 0.73, p = 0.024), II (R2 = − 0.48, p = 0.013), III (R2 = − 0.69, p < 0.0001), IV (R2 = − 0.69, p < 0.0001) and V discrepancy (R2 = − 0.58, p = 0.0018). Diseases from the respiratory system had significantly lower risks of any diagnostic errors (OR = 0.48, 95% 0.24–0.95, p = 0.036). A neoplasm carrier increased by 92% the risk of any diagnostic error (OR = 1.92; 95%CI 1.18–3.14; p = 0.009) and hypertension reduced by 78% the risk of minor errors (OR = 0.22, 95%CI 0.06–0.91, p = 0.036). Severity of discrepancy relieved over years and associated with ageing in patients with cardiovascular diseases (p = 0.01).ConclusionsThe rate of fatal medical disputes and diagnostic discrepancy declined after stepwise legislations in China. Respiratory diseases, neoplasm carrier and hypertension could be independent predictors for assessing diagnostic errors.

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Section: Discussioncontrasting

confidence: 56%

Diagnostic errors in fatal medical malpractice cases in Shanghai, China: 1990–2015

Gao

Zhao

et al. 2019

Diagn Pathol

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“…The diagnosis of HF or evaluation of cardiac dysfunction at autopsy is based predominantly on morphological and pathological findings. This includes the venous congestion of multiple organs, such as the lungs and liver, or a systemic low output state with ischemic arterioles and capillaries [84]. Acute cardiac dysfunction caused by early acute ischemic heart disease and fatal arrhythmia has become a difficult problem in the field of forensic science and pathology due to its high incidence and the lack of typical pathological changes [7,85,86].…”

Section: Bnp and Nt-probnp As Postmortem Biomarkers To Evaluate Camentioning

confidence: 99%

BNP and NT-proBNP as Diagnostic Biomarkers for Cardiac Dysfunction in Both Clinical and Forensic Medicine

Cao

Jia

Zhu

2019

IJMS

245

153

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Currently, brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are widely used as diagnostic biomarkers for heart failure (HF) and cardiac dysfunction in clinical medicine. They are also used as postmortem biomarkers reflecting cardiac function of the deceased before death in forensic medicine. Several previous studies have reviewed BNP and NT-proBNP in clinical medicine, however, few articles have reviewed their application in forensic medicine. The present article reviews the biological features, the research and application status, and the future research prospects of BNP and NT-proBNP in both clinical medicine and forensic medicine, thereby providing valuable assistance for clinicians and forensic pathologists.

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“…Correct diagnosis is important for patient care, as well as evidence for the number of morbidity and mortality [5]. Hospital autopsies are considered as "gold standard" for providing a definitive diagnosis and usually have been used to compare the clinical diagnosis with post-mortem findings [6]. Despite the significant progress in diagnostic procedures, ante-and postmortem diagnoses differ [7].…”

Section: Introductionmentioning

confidence: 99%

Discrepancies between clinical diagnosis and hospital autopsy: A comparative retrospective analysis of 1,112 cases

et al. 2021

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Aims The aim of this study was to compare discrepancies between diagnosed and autopsied causes of death in 1,112 hospital autopsies and to determine the factors causing this discrepancies. Methods 1,112 hospital autopsies between 2010 and 2013 were retrospectively studied. Ante-mortem diagnoses were compared to causes of death as determined by autopsy. Clinical diagnoses were extracted from the autopsy request form, and post-mortem diagnoses were assessed from respective autopsy reports. Variables, such as sex, age, Body Mass Index, category of disease, duration of hospital stay and new-borns were studied in comparison to discrepancy. P-values were derived from the Mann-Whitney U test for the constant features and chi-2 test, p-values < 0,05 were considered significant. Results 73.9% (n = 822) patients showed no discrepancy between autopsy and clinical diagnosis. The duration of hospitalisation (6 vs. 9 days) and diseases of the cardiovascular system (61.7%) had a significant impact on discrepancies. Conclusion Age, cardiovascular diseases and duration of hospital stay significantly affect discrepancies in ante- and post-mortem diagnoses.

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Diagnostic discrepancies in clinical practice

Cited by 18 publications

References 27 publications

Diagnostic errors in fatal medical malpractice cases in Shanghai, China: 1990–2015

Diagnostic errors in fatal medical malpractice cases in Shanghai, China: 1990–2015

BNP and NT-proBNP as Diagnostic Biomarkers for Cardiac Dysfunction in Both Clinical and Forensic Medicine

Discrepancies between clinical diagnosis and hospital autopsy: A comparative retrospective analysis of 1,112 cases

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