Diagnostic errors in the pediatric and neonatal ICU: a systematic review

Area of Science:

• Pediatric critical care medicine
• Diagnostic accuracy
• Patient safety research

Background:

• Diagnostic errors contribute to preventable morbidity and mortality in hospitalized patients.
• Pediatric intensive care units (PICU) and neonatal intensive care units (NICU) may pose unique risks for misdiagnosis.
• Limited data exists on diagnostic errors in pediatric intensive care settings.

Purpose of the Study:

• To systematically review and assess the rates and types of diagnostic errors in pediatric and neonatal intensive care units.
• To identify common causes of misdiagnosis in these critical care settings.

Main Methods:

• Systematic review of observational studies reporting autopsy-confirmed diagnostic errors.
• Searched major databases including PubMed, Embase, CINAHL, and Cochrane.
• Utilized standard Goldman criteria for evaluating diagnostic errors and abstracted data on patient characteristics and error classes.

Main Results:

• Included 13 studies (7 PICU, 6 neonatal ICU) involving over 1,000 PICU deaths and 2,100 neonatal deaths.
• Major diagnostic errors occurred in 19.6% of autopsied deaths (Class I: 4.5%, Class II: 15.1%).
• Infections were the most common cause of Class I errors in both settings, with vascular events more frequent in PICU and congenital/metabolic conditions in neonatal ICU.

Conclusions:

• Diagnostic errors, particularly those related to infections, are a significant concern in PICU and neonatal ICU settings.
• Further research is required to accurately quantify pediatric intensive care misdiagnoses and develop strategies to mitigate harm.
• Improving diagnostic accuracy is crucial for enhancing patient safety in pediatric critical care.