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Diagnostic errors in pediatric bacterial osteomyelitis
Yuki Otani1, Yuta Aizawa2,3, Hiroshi Hataya1
1Division of General Pediatrics, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan.
Insights
Pediatric septic osteomyelitis diagnosis errors are common, with nearly 40% of cases misdiagnosed. Cognitive errors, often linked to prior antibiotic use, were the primary cause, highlighting a need for improved diagnostic strategies in children.
Area of Science:
- Pediatric Medicine
- Diagnostic Accuracy
- Infectious Diseases
Background:
- Clinical evidence for improving diagnostic accuracy in pediatric medicine is limited.
- Septic osteomyelitis presents diagnostic challenges for pediatricians.
- Understanding diagnostic errors is crucial for enhancing patient care.
Purpose of the Study:
- To identify the incidence of diagnostic errors in pediatric osteomyelitis.
- To determine the reasons behind misdiagnosis of bacterial osteomyelitis in children.
- To improve patient care by analyzing diagnostic inaccuracies.
Main Methods:
- Retrospective review of pediatric patients (<16 years) with osteomyelitis (April 2010-September 2017).
- Data extraction included demographics, clinical course, symptoms, lesion location, and diagnoses.
- Patients categorized into misdiagnosis and non-misdiagnosis groups based on initial vs. discharge diagnosis.
Main Results:
- 71 pediatric patients were analyzed; 38% (27/71) experienced misdiagnosis.
- Prior antibiotic use was significantly associated with misdiagnosis (P=0.044).
- Cognitive errors accounted for 88.3% of misdiagnoses, with a median of 2 error types per case.
Conclusions:
- Misdiagnosis of pediatric septic osteomyelitis is frequent and primarily driven by cognitive errors.
- Addressing cognitive errors in diagnosis is essential for improving osteomyelitis patient care.
- Enhanced diagnostic strategies are needed to reduce errors in pediatric septic osteomyelitis.
Background:
Clinical evidence for improving diagnostic accuracy in pediatric medicine is still scarce. Septic osteomyelitis is sometimes challenging for physicians to diagnose. The aim of this study was to improve patient care through identifying the incidence and reasons for errors in the diagnosis of bacterial osteomyelitis in pediatric patients.
Methods:
We retrospectively identified patients younger than 16 years with acute or chronic osteomyelitis at Tokyo Metropolitan Children's Medical Center between April 2010 and September 2017. We extracted data on patient demographics, clinical course, symptoms, locus of the lesions, and diagnosis at presentation and discharge. The patients were categorized into the misdiagnosis and non-misdiagnosis groups following a review by two pediatricians. Misdiagnosis was defined as a difference between the initial and discharge diagnosis. The factors in the two groups were compared, and the types of error in the misdiagnosis group were examined.
Results:
In total 71 patients were enrolled. The median age and proportion of boys was 7.6 years (IQR, 1.4-11.2 years) and 66%, respectively. Misdiagnosis occurred in 27 patients (38.0%). Precedent antibiotic use was independently associated with misdiagnosis (P = 0.044). A cognitive error was observed in 88.3% of the misdiagnosis group. The median number of types of error per case was 2.0 (IQR, 2.0-3.0).
Conclusions:
The misdiagnosis of septic osteomyelitis in pediatric patients was common and chiefly caused by cognitive errors. Eliminating cognitive errors in diagnosis is highly likely to improve the care of patients with osteomyelitis.
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