Prevalence of harmful diagnostic errors in hospitalised adults: a systematic review and meta-analysis

Abstract

BackgroundDiagnostic error is commonly defined as a missed, delayed or wrong diagnosis and has been described as among the most important patient safety hazards. Diagnostic errors also account for the largest category of medical malpractice high severity claims and total payouts. Despite a large literature on the incidence of inpatient adverse events, no systematic review has attempted to estimate the prevalence and nature of harmful diagnostic errors in hospitalised patients.MethodsA systematic literature search was conducted using Medline, Embase, Web of Science and the Cochrane library from database inception through 9 July 2019. We included all studies of hospitalised adult patients that used physician review of case series of admissions and reported the frequency of diagnostic adverse events. Two reviewers independently screened studies for inclusion, extracted study characteristics and assessed risk of bias. Harmful diagnostic error rates were pooled using random-effects meta-analysis.ResultsTwenty-two studies including 80 026 patients and 760 harmful diagnostic errors from consecutive or randomly selected cohorts were pooled. The pooled rate was 0.7% (95% CI 0.5% to 1.1%). Of the 136 diagnostic errors that were described in detail, a wide range of diseases were missed, the most common being malignancy (n=15, 11%) and pulmonary embolism (n=13, 9.6%). In the USA, these estimates correspond to approximately 249 900 harmful diagnostic errors yearly.ConclusionBased on physician review, at least 0.7% of adult admissions involve a harmful diagnostic error. A wide range of diseases are missed, including many common diseases. Fourteen diagnoses account for more than half of all diagnostic errors. The finding that a wide range of common diagnoses are missed implies that efforts to improve diagnosis must target the basic processes of diagnosis, including both cognitive and system-related factors.PROSPERO registration numberCRD42018115186.

Consensus statement on the content of clinical reasoning curricula in undergraduate medical education

“…Clinical reasoning is of interest to educators because of its importance in clinical practice, particularly in relation to diagnostic error. Diagnostic errors tend to occur in common diseases (Gunderson et al 2020) and are a significant cause of preventable harm to patients worldwide (Tehrani et al 2013;World Health Organization 2016). Cognitive failures, such as failure to synthesise all the available information correctly or failure to use the physical examination findings or test results appropriately, have been found to…”

Delayed Diagnosis of Duodenal Atresia in an 11 Year Old

“…As such, process improvement in the diagnostic course can be a point of potential intervention to mitigate these errors. 6 This concept can be extended to other patient populations, including pediatrics, to bolster the efforts of augmenting patient safety by encouraging thorough and thoughtful diagnostic processes.…”

Diagnostic error in hospitals: finding forests not just the big trees

“…Gunderson and colleagues performed a systematic review and meta-analysis to inform a new estimate for the prevalence of diagnostic adverse events among hospitalised patients, a rate of 0.7%. 6 Their review shows how diagnostic error is a global problem, with studies from countries across five continents. The prevalence however is lower than what might be expected looking at previous research, mostly in outpatient care, and based on expert estimates.…”

“…Some diagnostic adverse events may also be classified as 'other' types; for instance delayed diagnosis of a wound leakage after surgery is often considered a surgical complication and not categorised as a delay in diagnosis. 16 Studies in the review also detected adverse events (ie, errors that resulted in harm) 6 which is a subgroup of diagnostic errors, because not every diagnostic error results in harm. 17 Lastly, while the random selection of patients is a strength for determining prevalence of medical error, not all admissions involve making a diagnosis-patients are often hospitalised for treatment and procedures.…”

“…6 7 Gunderson and colleagues conducted a systematic review to determine the prevalence of harmful diagnostic errors in hospitalised patients. 6 Raffel and colleagues studied readmitted patients using established methods for diagnostic error detection and analysis to gain insights into contributing factors. 7 Both studies advance the science of measurement and understanding of how to reduce diagnostic error in hospitals.…”