Discordance in interpretation of chest radiographs between pediatric intensivists and a radiologist: Impact on patient management

Нестерова, Галина Владимировна; Leftridge, Clifton A.; Natarajan, Aruna; Appel, Heidi J.; Bautista, Manuel; Hauser, Gabriel J.

doi:10.1016/j.jcrc.2009.05.016

Cited by 12 publications

(3 citation statements)

References 16 publications

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“…Two studies reported a 7–46% rate of discrepancies in interpretation of radiographs (chest radiograph and abdominal x-ray) between PICU physicians and radiologists. Among discrepancies, 9–13% were found to be actionable and led to a change in management (17, 18). Common actionable discrepancies included failure to recognize line/tube malposition and misinterpretation of air space disease and atelectasis (17, 18).…”

Section: Resultsmentioning

confidence: 99%

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Diagnostic Errors in Pediatric Critical Care: A Systematic Review*

Cifra

Custer

Singh

et al. 2021

Pediatric Critical Care Medicine

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Studies on diagnostic error and the diagnostic process in pediatric critical care were included. Non-English studies with no translation, case reports/series, studies providing no information on diagnostic error, studies focused on non-PICU populations, and studies focused on a single condition/disease or a single diagnostic test/tool were excluded.DATA EXTRACTION: Data on research design, objectives, study sample, and results pertaining to the prevalence, impact, and factors associated with diagnostic error were abstracted from each study.DATA SYNTHESIS: Using independent tiered review, 396 abstracts were screened, and 17 studies (14 full-text, 3 abstracts) were ultimately included. Fifteen of 17 studies (88%) had an observational research design. Autopsy studies (autopsy rates were 20-47%) showed a 10-23% rate of missed major diagnoses; 5-16% of autopsy-discovered diagnostic errors had a potential adverse impact on survival and would have changed management. Retrospective record reviews reported varying rates of diagnostic error from 8% in a general PICU population to 12% among unexpected critical admissions and 21-25% of patients discussed at PICU morbidity and mortality conferences. Cardiovascular, infectious, congenital, and neurologic conditions were most commonly misdiagnosed. Systems factors (40-67%), cognitive factors (20-3%), and both systems and cognitive factors (40%) were associated with diagnostic error. Limited information was available on the impact of misdiagnosis.CONCLUSIONS: Knowledge of diagnostic errors in the PICU is limited. Future work to understand diagnostic errors should involve a balanced focus between studying the diagnosis of individual diseases and uncovering common system-and process-related determinants of diagnostic error.

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Section: Resultsmentioning

confidence: 99%

“…Among discrepancies, 9–13% were found to be actionable and led to a change in management (17, 18). Common actionable discrepancies included failure to recognize line/tube malposition and misinterpretation of air space disease and atelectasis (17, 18).…”

Section: Resultsmentioning

confidence: 99%