Errors of Diagnosis in Pediatric Practice: A Multisite Survey

Singh, Hardeep; Thomas, Eric J.; Wilson, Lindsey; Kelly, P. Adam; Pietz, Kenneth; Elkeeb, Dena; Singhal, Geeta

doi:10.1542/peds.2009-3218

Cited by 113 publications

(91 citation statements)

References 44 publications

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“…A recent telephone survey of a random probability sample of over 2000 US adults suggested that more than one in 10 respondents reported a ‘diagnostic mishap’ 19. Similarly, a survey of 726 paediatricians revealed that more than half (54%) reported making a diagnostic error at least once or twice per month 20. Thus, other recent data corroborate our finding that diagnostic errors are common.…”

Section: Discussionsupporting

confidence: 90%

The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations

Singh¹,

2014

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BackgroundThe frequency of outpatient diagnostic errors is challenging to determine due to varying error definitions and the need to review data across multiple providers and care settings over time. We estimated the frequency of diagnostic errors in the US adult population by synthesising data from three previous studies of clinic-based populations that used conceptually similar definitions of diagnostic error.MethodsData sources included two previous studies that used electronic triggers, or algorithms, to detect unusual patterns of return visits after an initial primary care visit or lack of follow-up of abnormal clinical findings related to colorectal cancer, both suggestive of diagnostic errors. A third study examined consecutive cases of lung cancer. In all three studies, diagnostic errors were confirmed through chart review and defined as missed opportunities to make a timely or correct diagnosis based on available evidence. We extrapolated the frequency of diagnostic error obtained from our studies to the US adult population, using the primary care study to estimate rates of diagnostic error for acute conditions (and exacerbations of existing conditions) and the two cancer studies to conservatively estimate rates of missed diagnosis of colorectal and lung cancer (as proxies for other serious chronic conditions).ResultsCombining estimates from the three studies yielded a rate of outpatient diagnostic errors of 5.08%, or approximately 12 million US adults every year. Based upon previous work, we estimate that about half of these errors could potentially be harmful.ConclusionsOur population-based estimate suggests that diagnostic errors affect at least 1 in 20 US adults. This foundational evidence should encourage policymakers, healthcare organisations and researchers to start measuring and reducing diagnostic errors.

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Section: Discussionsupporting

confidence: 90%

The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations

Singh¹,

2014

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“…10,11 Second, concern over diagnostic errors might prompt CT use. Appendicitis is among the leading diagnoses associated with pediatric diagnostic errors 22 and malpractice claims. 23 Low physician risk tolerance among emergency medicine physicians has been associated with more frequent CT use for evaluation of adult acute abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

Use and Accuracy of Diagnostic Imaging by Hospital Type in Pediatric Appendicitis

Saito¹,

Yan

Evashwick³

et al. 2013

Pediatrics

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Widespread preoperative imaging did not eliminate unnecessary pediatric appendectomies. Controlling for factors potentially associated with referral bias, a CT scan was more likely to be performed in children initially evaluated at community hospitals compared with the children's hospital. Broadly-applicable strategies to systematically maximize diagnostic accuracy for childhood appendicitis, while minimizing ionizing radiation exposure, are urgently needed.

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“…A survey of over 2000 patients found that 55% listed a diagnostic error as their chief concern when seeing a physician in an outpatient setting 21. Similarly, physician surveys have consistently found that approximately half the respondents encounter diagnostic errors at least monthly 11 22 23. Moreover, compared with the many different safety concerns encountered in practice, physicians perceive diagnostic errors to be more likely to cause serious harm or death compared with other safety concerns 24…”

Section: The Incidence Of Diagnostic Errormentioning

confidence: 94%

The incidence of diagnostic error in medicine

2013

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A wide variety of research studies suggest that breakdowns in the diagnostic process result in a staggering toll of harm and patient deaths. These include autopsy studies, case reviews, surveys of patient and physicians, voluntary reporting systems, using standardised patients, second reviews, diagnostic testing audits and closed claims reviews. Although these different approaches provide important information and unique insights regarding diagnostic errors, each has limitations and none is well suited to establishing the incidence of diagnostic error in actual practice, or the aggregate rate of error and harm. We argue that being able to measure the incidence of diagnostic error is essential to enable research studies on diagnostic error, and to initiate quality improvement projects aimed at reducing the risk of error and harm. Three approaches appear most promising in this regard: (1) using ‘trigger tools’ to identify from electronic health records cases at high risk for diagnostic error; (2) using standardised patients (secret shoppers) to study the rate of error in practice; (3) encouraging both patients and physicians to voluntarily report errors they encounter, and facilitating this process.

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Errors of Diagnosis in Pediatric Practice: A Multisite Survey

Cited by 113 publications

References 44 publications

The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations

The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations

Use and Accuracy of Diagnostic Imaging by Hospital Type in Pediatric Appendicitis

The incidence of diagnostic error in medicine

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