Misdiagnoses in the Context of Suspected Pandemic Influenza or Coronavirus Disease 2019: A Systematic Review

Abstract

There have been numerous reports of patients initially misdiagnosed in the H1N1 and COVID-19 pandemics within the literature. A systematic review was undertaken to collate misdiagnoses during the H1N1/2009 and COVID-19 pandemics and identify which cognitive biases may contribute to this. MEDLINE, Embase, Cochrane and MedRxiv databases were searched for misdiagnoses or cognitive biases resulting in misdiagnosis, occurring during the H1N1/2009 or COVID-19 virus pandemics. Eligible studies were quality assessed using JBI criteria; primary outcome was final diagnosis. Sixty-nine studies involving 2551 participants were included. We identified 686 cases of misdiagnosis, categorised as viral respiratory infection, bacterial respiratory infection, non-respiratory infection, and non-infective. Misdiagnoses are listed and relevant investigations are offered. No article described prospective assessment of decision-making in the pandemic setting or de-biasing diagnostic thinking. Further research is required to understand why misdiagnoses occur, harm arising, and how clinicians can be assisted in their decision-making in a pandemic context.

A pitfall of cognitive bias during the pandemic: Two cases of Plasmodium falciparum malaria coinfected or misdiagnosed with COVID-19

“…Misdiagnosis has been reported not only during the COVID-19 pandemic but also during the 2009 H1N1 influenza pandemic. Lucy et al reviewed 16 eligible studies and identified 686 misdiagnoses with 97 final diagnoses [ 6 ]. In their systematic review, respiratory infections accounted for the majority (72%), and nonrespiratory infections (14%) and noninfectious diseases accounted for the remainder (14%).…”

“…Numerous cases that were initially misdiagnosed during the COVID-19 pandemic have been reported. Cognitive biases such as anchoring or premature closure have been shown to contribute to these misdiagnoses in some cases [ 6 ]. Diagnostic errors caused by cognitive biases during the pandemic could lead to fatal outcomes in patients with malaria because Plasmodium falciparum malaria needs to be diagnosed and treated as early as possible.…”

Infezioni in Medicina

“…Although COVID-19 represents one of the most important diseases nowadays, it must not mask other diseases that may have another type of therapeutic management [73]. Misdiagnosis during the COVID-19 pandemic has become highly frequent; several infectious diseases and chronic non-communicable diseases have been reported to be misdiagnosed with COVID-19, mainly when the clinical presentation had an atypical course [74]. Misdiagnosis occurs mainly with other etiologies that cause respiratory compromise, like several mycoses and bacterial infections, among others; however, it is possible that other non-specific infectious diseases might be misdiagnosed as COVID-19 [75,76].…”