Progress understanding diagnosis and diagnostic errors: thoughts at year 10

Graber, Mark L.

doi:10.1515/dx-2020-0055

Cited by 21 publications

(14 citation statements)

References 54 publications

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“…Recently, there has been a remarkable increase in the level of attention and development in the field of diagnostic errors, with the volume of publications having rapidly increased 1 . The frequency and impact of diagnostic errors on medical care are increasing, with diagnostic errors reported in 5% of outpatient cases 2 , 10% of in-hospital deaths 3 , and 7–17% of in-hospital adverse events 4 , 5 .…”

Section: Introductionmentioning

confidence: 99%

Diagnostic error rates and associated factors for lower gastrointestinal perforation

Harada

Watari

Watanuki

et al. 2022

Sci Rep

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Lower gastrointestinal perforation is rare and challenging to diagnose in patients presenting with an acute abdomen. However, no study has examined the frequency and associated factors of diagnostic errors related to lower gastrointestinal perforation. This large-scale multicenter retrospective study investigated the frequency of diagnostic errors and identified the associated factors. Factors at the level of the patient, symptoms, situation, and physician were included in the analysis. Data were collected from nine institutions, between January 1, 2015 and December 31, 2019. Timely diagnosis was defined as diagnosis at the first visit in computed tomography (CT)-capable facilities or referral to an appropriate medical institution immediately following the first visit to a non-CT-capable facility. Cases not meeting this definition were defined as diagnostic errors that resulted in delayed diagnosis. Of the 439 cases of lower gastrointestinal perforation identified, delayed diagnosis occurred in 138 cases (31.4%). Multivariate logistic regression analysis revealed a significant association between examination by a non-generalist and delayed diagnosis. Other factors showing a tendency with delayed diagnosis included presence of fever, absence of abdominal tenderness, and unavailability of urgent radiology reports. Initial misdiagnoses were mainly gastroenteritis, constipation, and small bowel obstruction. In conclusion, diagnostic errors occurred in about one-third of patients with a lower gastrointestinal perforation.

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Section: Introductionmentioning

confidence: 99%

Diagnostic error rates and associated factors for lower gastrointestinal perforation

Harada

Watari

Watanuki

et al. 2022

Sci Rep

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“…In our scoping review, two studies on NPs were included. In recent years, there has been a paradigm shift in the diagnostic process, with diagnoses no longer being made by physicians alone, but rather as a collaborative process involving patients and multiple professionals [62]. In a scoping review conducted by Abdellatif et al [63] on the benefits of CDSS in nursing home settings, not only physicians but also nurses and pharmacists were found to benefit from CDSS in correcting malnutrition, pressure ulcer prevention, drug prescription, and disease management.…”

Section: Discussionmentioning

confidence: 99%

Clinical Decision Support Systems for Diagnosis in Primary Care: A Scoping Review

Harada

Miyagami

Kunitomo

et al. 2021

IJERPH

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Diagnosis is one of the crucial tasks performed by primary care physicians; however, primary care is at high risk of diagnostic errors due to the characteristics and uncertainties associated with the field. Prevention of diagnostic errors in primary care requires urgent action, and one of the possible methods is the use of health information technology. Its modes such as clinical decision support systems (CDSS) have been demonstrated to improve the quality of care in a variety of medical settings, including hospitals and primary care centers, though its usefulness in the diagnostic domain is still unknown. We conducted a scoping review to confirm the usefulness of the CDSS in the diagnostic domain in primary care and to identify areas that need to be explored. Search terms were chosen to cover the three dimensions of interest: decision support systems, diagnosis, and primary care. A total of 26 studies were included in the review. As a result, we found that the CDSS and reminder tools have significant effects on screening for common chronic diseases; however, the CDSS has not yet been fully validated for the diagnosis of acute and uncommon chronic diseases. Moreover, there were few studies involving non-physicians.

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“…On the other hand, we are now at a stage where the concept of situativity, which encompasses the multiple professions surrounding the physician and patient and the medical environment, will impact the diagnosis [ 2 ]. Thus, a multifaceted understanding of diagnosis will be increasingly required for physicians [ 3 ].…”

Section: Redefining Systemmentioning

confidence: 99%

System 2 Diagnostic Process for the Next Generation of Physicians: “Inside” and “Outside” Brain—The Interplay between Human and Machine

Shimizu

2022

Diagnostics

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Improving diagnosis has been one of the most critical issues in medicine for the last two decades. In the context of the rise of digital health and its augmentation and human diagnostic thinking, it has become necessary to integrate the concept of digital diagnosis into dual-process theory (DPT), which is the fundamental axis of the diagnostic thinking process physicians. Particularly, since the clinical decision support system (CDSS) corresponds to analytical thinking (system 2) in DPT, it is necessary to redefine system 2 to include the CDSS. However, to the best of my knowledge there has been no concrete conceptual model based on this need. The innovation and novelty of this paper are that it redefines system 2 to include new concepts and shows the relationship among the breakdown of system 2. In this definition, system 2 is divided into “inside” and “outside” brains, where “inside” includes symptomatologic, anatomical, biomechanical–physiological, and etiological thinking approaches, and “outside” includes CDSS. Moreover, this paper discusses the actual and possible future interplay between “inside” and “outside.” The author envisions that this paper will serve as a cornerstone for the future development of system 2 diagnostic thinking strategy.

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Progress understanding diagnosis and diagnostic errors: thoughts at year 10

Abstract: Baseball Umpire #1 I call 'em as I see 'em Baseball Umpire #2 I call 'em as they are Baseball Umpire #3 They ain't nothin' till I call 'em Richard E. Nisbett Mindware-Tools for Smart Thinking

Cited by 21 publications

References 54 publications

Diagnostic error rates and associated factors for lower gastrointestinal perforation

Diagnostic error rates and associated factors for lower gastrointestinal perforation

Clinical Decision Support Systems for Diagnosis in Primary Care: A Scoping Review

System 2 Diagnostic Process for the Next Generation of Physicians: “Inside” and “Outside” Brain—The Interplay between Human and Machine

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