Understanding diagnostic error: looking beyond diagnostic accuracy

Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient. Thus, it poses special challenges for measurement. In this paper, we discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. We highlight challenges and opportunities for developing potential measures of “diagnostic safety” related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, we propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety, and call for these to be studied and further refined. This would enable safe diagnosis to become an organizational priority and facilitate quality improvement. Health care systems should consider measurement and evaluation of diagnostic performance as essential to timely and accurate diagnosis and to the reduction of preventable diagnostic harm.

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“…This approach is consistent with the fact that diagnosis is a “team sport” where patients play a critical role. 63 …”

Section: Summary and Recommendationsmentioning

confidence: 99%

Measures to Improve Diagnostic Safety in Clinical Practice

2016

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“…The evaluation of resting and movement pain intensity is useful not only for diagnostic assessment but also for prognosis and follow-up of muscle injuries: for example, the Functional Assessment Scale for Acute Hamstrings Injuries (FASH) investigates the severity of pain in resting and different movement conditions and provides a valid, reproducible and responsive outcome measure for the prognostic assessment and monitoring of patients with hamstrings injuries [17]. Besides the pain intensity, other anamnestic and clinical data could also be collected to improve the diagnostic accuracy: however, clinicians' omissions in gathering further critical information may hinder the appropriate disease diagnosis and management [18,19]. For example, the assessment of pain distribution and onset modality (sudden onset vs progressive or delayed onset) could provide useful insights to distinguish between functional disorders (such as fatigue-induced muscle disorder or delayed onset muscle soreness) and structural injuries.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic performance of the Strength and Pain Assessment (SPA) score for non-contact muscle injury screening in male soccer players

Semperboni

Vignati

Ballatore

et al. 2020

The Physician and Sportsmedicine

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Objectives:The aims of this study were to develop a clinical-feature based scoring system for muscle injury screening and to assess its diagnostic accuracy when large number of injuries are suspected. Methods: A prospective diagnostic accuracy study was performed according to the Standards for Reporting of Diagnostic Accuracy (STARD) criteria. The diagnostic accuracy of the Strength and Pain Assessment (SPA) score (index test) was assessed in relation to muscle ultrasonography (reference standard). A large (n = 175) number of male soccer players met the inclusion/exclusion criteria: clinical assessment (i.e., evaluation of pain onset modality, location, distribution, impact on performance, and manual muscle strength testing) and ultrasonography were performed in all players after 48 hours from the sudden or progressive onset of muscle pain during or after a soccer competition. Results: 91 of 175 cases (52%) were classified as functional muscle disorders, while signs of muscle tear were observed in the remaining 84 of 175 (48%) cases that were classified as structural muscle injuries. The median (1st -3rd quartile) value of the SPA score was significantly (P < 0.001) lower in the functional disorder group [9 (9-10)] compared to the structural injury group [12 (12-13)]. The area under the Receiver Operating Characteristic curve for different cutoff points of the SPA score was 0.977 (95% confidence intervals: 0.957-0.998) and the optimal cutoff value of the SPA score providing the greatest sensitivity and specificity (respectively, 99% and 89%) was 11. Conclusion:This study found that the SPA score has high diagnostic accuracy for structural muscle injuries and could be used as a valid screening tool in soccer players presenting with sudden or progressive onset of muscle pain during or after a competition.

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Understanding diagnostic error: looking beyond diagnostic accuracy

Cited by 2 publications

References 18 publications

Measures to Improve Diagnostic Safety in Clinical Practice

Measures to Improve Diagnostic Safety in Clinical Practice

Diagnostic performance of the Strength and Pain Assessment (SPA) score for non-contact muscle injury screening in male soccer players

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