Journal article
Diagnostic Uncertainty Among Critically Ill Children Admitted to the PICU: A Multicenter Study
Critical care medicine, Vol.53(2), pp.e294-e307
02/2025
DOI: 10.1097/CCM.0000000000006511
PMCID: PMC13048364
PMID: 39585176
Abstract
This study aimed to identify the prevalence of and factors associated with diagnostic uncertainty when critically ill children are admitted to the PICU. Understanding diagnostic uncertainty is necessary to develop effective strategies to reduce diagnostic errors in the PICU.
Multicenter retrospective cohort study with structured medical record review by trained clinicians using a standardized instrument to identify diagnostic uncertainty in narrative clinical notes. Diagnoses and diagnostic uncertainty were compared across time from PICU admission to hospital discharge. Generalized linear mixed models were used to determine patient, clinician, and encounter characteristics associated with diagnostic uncertainty at PICU admission.
Four academic tertiary-referral PICUs.
Eight hundred eighty-two randomly selected patients 0-18 years old who were nonelectively admitted to participating PICUs.
None.
PICU admission notes for 228 of 882 patients (25.9%) indicated diagnostic uncertainty. Patients with uncertainty decreased over time but 58 (6.6%) had remaining diagnostic uncertainty at hospital discharge. Multivariable analysis showed that diagnostic uncertainty was significantly associated with off hours admission (odds ratio [OR], 1.52; p = 0.037), greater severity of illness (OR, 1.04; p = 0.025), an atypical presentation (OR, 2.14; p = 0.046), diagnostic discordance at admission between attending intensivists and resident physicians/advanced practice providers (OR, 3.62; p < 0.001), and having a neurologic primary diagnosis (OR, 1.87; p = 0.03). Older patients (OR, 0.96; p = 0.014) and those with a respiratory (OR, 0.58; p = 0.009) or trauma primary diagnosis (OR, 0.08; p < 0.001) were less likely to have diagnostic uncertainty. There were no significant associations between diagnostic uncertainty and attending intensivists' characteristics.
Diagnostic uncertainty at PICU admission was common and was associated with off hours admission, severe illness, atypical presentation, diagnostic discordance between clinicians, and a neurologic primary diagnosis. Further study on the recognition and management of diagnostic uncertainty is needed to inform interventions to improve diagnosis among critically ill children.
Details
- Title: Subtitle
- Diagnostic Uncertainty Among Critically Ill Children Admitted to the PICU: A Multicenter Study
- Creators
- Christina L Cifra - Boston Children's HospitalJason W Custer - University of Maryland, BaltimoreCraig M Smith - Northwestern UniversityKristen A Smith - University of MichiganDayanand N Bagdure - Louisiana State University Health Sciences Center ShreveportJodi Bloxham - University of IowaEmily Goldhar - Lurie Children's HospitalStephen M Gorga - University of MichiganElizabeth M Hoppe - Lurie Children's HospitalChristina D Miller - University of Colorado DenverMax Pizzo - University of MichiganSonali Ramesh - University of Missouri–Kansas CityJoseph RiffeKatharine Robb - University of IowaShari L Simone - University of Maryland, BaltimoreHaley D Stoll - University of IowaJamie Ann Tumulty - University of Maryland, BaltimoreStephanie E Wall - University of MichiganPatrick Ten Eyck - University of IowaKatie K Wolfe - Washington University in St. Louis School of MedicineChristopher P Landrigan - Boston Children's HospitalLinder Wendt - University of IowaJeffrey D Dawson - University of IowaHeather Schacht Reisinger - University of IowaHardeep Singh - Michael E. DeBakey VA Medical CenterLoreen A Herwaldt - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Critical care medicine, Vol.53(2), pp.e294-e307
- DOI
- 10.1097/CCM.0000000000006511
- PMID
- 39585176
- PMCID
- PMC13048364
- NLM abbreviation
- Crit Care Med
- ISSN
- 0090-3493
- eISSN
- 1530-0293
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Grant note
- Eunice Kennedy Shriver National Institute of Child Health and Human Development through a K12 grant to the University of Iowa Stead Family Department of Pediatrics: HD02774828 Agency for Healthcare Research and Quality through a K08 grant: HS026965 University of Iowa Carver College of Medicine Department of PediatricsBoston Children's Hospital Division of Medical Critical CareNational Center for Advancing Translational Sciences of the National Institutes of Health through the University of Iowa's Institute for Clinical and Translational Science: UM1TR004403
This work and the article's first author, Dr. Cifra, was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development through a K12 grant to the University of Iowa Stead Family Department of Pediatrics (No. HD02774828), Agency for Healthcare Research and Quality through a K08 grant (No. HS026965), and internal start-up grants from the University of Iowa Carver College of Medicine Department of Pediatrics and the Boston Children's Hospital Division of Medical Critical Care. This work was further supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (No. UM1TR004403) through the University of Iowa's Institute for Clinical and Translational Science.
- Language
- English
- Electronic publication date
- 11/25/2024
- Date published
- 02/2025
- Academic Unit
- Public Health Administration; Infectious Diseases; Stead Family Department of Pediatrics; Epidemiology; Biostatistics; Nursing; Center for Social Science Innovation; Internal Medicine; Design Biostat and Ethics
- Record Identifier
- 9984751757402771
Metrics
14 Record Views