Impact of diagnostic errors on adverse outcomes: learning from emergency department revisits with repeat CT or MRI

Abstract

Background To investigate diagnostic errors and their association with adverse outcomes (AOs) during patient revisits with repeat imaging (RVRIs) in the emergency department (ED). Results Diagnostic errors stemming from index imaging studies and AOs within 30 days in 1054 RVRIs (≤ 7 days) from 2005 to 2015 were retrospectively analyzed according to revisit timing (early [≤ 72 h] or late [> 72 h to 7 days] RVRIs). Risk factors for AOs were assessed using multivariable logistic analysis. The AO rate in the diagnostic error group was significantly higher than that in the non-error group (33.3% [77 of 231] vs. 14.8% [122 of 823], p < .001). The AO rate was the highest in early revisits within 72 h if diagnostic errors occurred (36.2%, 54 of 149). The most common diseases associated with diagnostic errors were digestive diseases in the radiologic misdiagnosis category (47.5%, 28 of 59) and neurologic diseases in the delayed radiology reporting time (46.8%, 29 of 62) and clinician error (27.3%, 30 of 110) categories. In the matched set of the AO and non-AO groups, multivariable logistic regression analysis revealed that the following diagnostic errors contributed to AO occurrence: radiologic error (odds ratio [OR] 3.56; p < .001) in total RVRIs, radiologic error (OR 3.70; p = .001) and clinician error (OR 4.82; p = .03) in early RVRIs, and radiologic error (OR 3.36; p = .02) in late RVRIs. Conclusion Diagnostic errors in index imaging studies are strongly associated with high AO rates in RVRIs in the ED.

Patient recalls associated with resident-to-attending radiology report discrepancies: predictive factors for risky discrepancies

“…The RRDs were categorized on a scale from 1‒4 according to the patients’ disposition and outcomes [ 2 , 16 ]. Category 1 was a minor discrepancy with no additional immediate action needed.…”

“…Category 3 included direct admission from the ED to the hospital and admissions from outpatient follow-up clinics after ED revisits to the hospital. The adverse outcomes defining category 4 were determined by referring to published literature, wherein adverse outcomes are defined as suboptimal patient experiences [ 16 , 17 ]. In the case of patients being followed up by an outpatient clinic, electronic medical records were evaluated and analyzed to determine whether adverse or major adverse outcomes occurred (> 30 days).…”

Influence of Prior Imaging Information on Diagnostic Accuracy for Focal Skeletal Processes—A Retrospective Analysis of the Consistency between Biopsy-Verified Imaging Diagnoses

“…Radiology is one of the specialties most liable to claims of diagnostic negligence, which can be defined as errors resulting in incorrect, delayed, or missed diagnoses [ 1 , 2 , 3 ]. Several studies have investigated the incidence and causes of medical errors, but such analyses remain challenging due to the lack of effective methods for measurement and limited sources of reliable data [ 4 ].…”