Journal article
Prevalence and Characteristics of Diagnostic Error in Pediatric Critical Care: A Multicenter Study
Critical care medicine, Vol.51(11), pp.1492-1501
11/2023
DOI: 10.1097/CCM.0000000000005942
PMCID: PMC10615661
PMID: 37246919
Abstract
Effective interventions to prevent diagnostic error among critically ill children should be informed by diagnostic error prevalence and etiologies. We aimed to determine the prevalence and characteristics of diagnostic errors and identify factors associated with error in patients admitted to the PICU.
Multicenter retrospective cohort study using structured medical record review by trained clinicians using the Revised Safer Dx instrument to identify diagnostic error (defined as missed opportunities in diagnosis). Cases with potential errors were further reviewed by four pediatric intensivists who made final consensus determinations of diagnostic error occurrence. Demographic, clinical, clinician, and encounter data were also collected.
Four academic tertiary-referral PICUs.
Eight hundred eighty-two randomly selected patients 0-18 years old who were nonelectively admitted to participating PICUs.
None.
Of 882 patient admissions, 13 (1.5%) had a diagnostic error up to 7 days after PICU admission. Infections (46%) and respiratory conditions (23%) were the most common missed diagnoses. One diagnostic error caused harm with a prolonged hospital stay. Common missed diagnostic opportunities included failure to consider the diagnosis despite a suggestive history (69%) and failure to broaden diagnostic testing (69%). Unadjusted analysis identified more diagnostic errors in patients with atypical presentations (23.1% vs 3.6%, p = 0.011), neurologic chief complaints (46.2% vs 18.8%, p = 0.024), admitting intensivists greater than or equal to 45 years old (92.3% vs 65.1%, p = 0.042), admitting intensivists with more service weeks/year (mean 12.8 vs 10.9 wk, p = 0.031), and diagnostic uncertainty on admission (77% vs 25.1%, p < 0.001). Generalized linear mixed models determined that atypical presentation (odds ratio [OR] 4.58; 95% CI, 0.94-17.1) and diagnostic uncertainty on admission (OR 9.67; 95% CI, 2.86-44.0) were significantly associated with diagnostic error.
Among critically ill children, 1.5% had a diagnostic error up to 7 days after PICU admission. Diagnostic errors were associated with atypical presentations and diagnostic uncertainty on admission, suggesting possible targets for intervention.
Details
- Title: Subtitle
- Prevalence and Characteristics of Diagnostic Error in Pediatric Critical Care: A Multicenter Study
- Creators
- Emily Goldhar - Lurie Children's HospitalStephen M Gorga - University of Michigan Medical SchoolElizabeth M Hoppe - Lurie Children's HospitalChristina D Miller - University of Colorado Anschutz Medical CampusMax Pizzo - University of MichiganSonali Ramesh - Department of Pediatrics, BronxCare Health System, New York, NY.Joseph Riffe - Department ofKatharine 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 MichiganKatie K Wolfe - Washington University in St. Louis School of MedicineLinder Wendt - University of IowaChristina L Cifra - University of IowaPatrick Ten Eyck - University of IowaJason W Custer - University of Maryland, BaltimoreChristopher P Landrigan - Boston Children's HospitalCraig M Smith - Northwestern MedicineJeffrey D Dawson - University of IowaKristen A Smith - University of Michigan Medical SchoolHeather Schacht Reisinger - University of IowaDayanand N Bagdure - Louisiana State University in ShreveportHardeep Singh - Michael E. DeBakey VA Medical CenterJodi Bloxham - University of IowaLoreen A Herwaldt - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Critical care medicine, Vol.51(11), pp.1492-1501
- DOI
- 10.1097/CCM.0000000000005942
- PMID
- 37246919
- PMCID
- PMC10615661
- NLM abbreviation
- Crit Care Med
- eISSN
- 1530-0293
- Grant note
- K12 HD027748 / NICHD NIH HHS K08 HS026965 / AHRQ HHS U54 TR001356 / NCATS NIH HHS
- Language
- English
- Electronic publication date
- 05/29/2023
- Date published
- 11/2023
- 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
- 9984420934302771
Metrics
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