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Diagnostic errors in pediatric radiology
George A Taylor1, Stephan D Voss, Patrice R Melvin
1Department of Radiology, Harvard Medical School, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA. george.taylor@childrens.harvard.edu
Background:
Little information is known about the frequency, types and causes of diagnostic errors in imaging children.
Objective:
Our goals were to describe the patterns and potential etiologies of diagnostic error in our subspecialty.
Materials And Methods:
We reviewed 265 cases with clinically significant diagnostic errors identified during a 10-year period. Errors were defined as a diagnosis that was delayed, wrong or missed; they were classified as perceptual, cognitive, system-related or unavoidable; and they were evaluated by imaging modality and level of training of the physician involved.
Results:
We identified 484 specific errors in the 265 cases reviewed (mean:1.8 errors/case). Most discrepancies involved staff (45.5%). Two hundred fifty-eight individual cognitive errors were identified in 151 cases (mean = 1.7 errors/case). Of these, 83 cases (55%) had additional perceptual or system-related errors. One hundred sixty-five perceptual errors were identified in 165 cases. Of these, 68 cases (41%) also had cognitive or system-related errors. Fifty-four system-related errors were identified in 46 cases (mean = 1.2 errors/case) of which all were multi-factorial. Seven cases were unavoidable.
Conclusion:
Our study defines a taxonomy of diagnostic errors in a large academic pediatric radiology practice and suggests that most are multi-factorial in etiology. Further study is needed to define effective strategies for improvement.
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