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Errors in Diagnosing Infectious Diseases: A Physician Survey
Mahboubeh Haddad1, Fereshte Sheybani1, HamidReza Naderi1
1Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Abstract:
Background: Infectious diseases are commonly missed or misdiagnosed. Errors in diagnosing infectious diseases not only affect the patient but also the community health. Objectives: To describe our investigation on the most common errors in diagnosing infectious diseases and their causes according to the physicians' reports. Methods: Between August 2018 and February 2019, specialist physicians and residents across Mashhad, Iran were invited to participate in a survey to report errors they had made or witnessed regarding the diagnosis of infectious diseases. Results: Overall, 465 cases were reported by 315 participants. The most common infectious diseases affected by diagnostic errors were upper respiratory tract infections (URTIs) (n = 69, 14.8%), tuberculosis (TB) (n = 66, 14.1%), pleuro-pulmonary infections (n = 54, 11.6%), central nervous system (CNS) infections (n = 51, 10.9%), and urinary tract infections (n = 45, 9.6%). Errors occurred most frequently in generating a diagnostic hypothesis (n = 259, 55/7%), followed by history taking (n = 200, 43%), and physical examination (n = 191, 41/1%). Errors related to the diagnosis of TB (odds ratio [OR]: 2.4, 95% confidence interval [CI]:0.9-5.7; P value: 0.047) and intra-abdominal infections (OR: 7.2, 95% CI: 0.9-53.8; P value: 0.02) were associated with more-serious outcomes. Conclusion: A substantial proportion of errors in diagnosing infectious diseases moderately or seriously affect patients' outcomes. URTIs, TB, and pleuropulmonary infections were the most frequently reported infectious diseases involved in diagnostic error while errors related to the diagnosis of TB and intraabdominal infections were more frequently associated with poor outcomes. Therefore, contagious and potentially life-threatening infectious diseases should always be considered in the differential diagnosis of patients who present with compatible clinical syndromes.
Insights
Diagnostic errors in infectious diseases significantly impact patient outcomes. Upper respiratory tract infections and tuberculosis were most frequently misdiagnosed, with TB and intra-abdominal infections leading to severe consequences.
Area of Science:
- Medical Diagnostics
- Infectious Disease Epidemiology
- Patient Safety
Background:
- Infectious diseases are frequently misdiagnosed, leading to adverse patient and community health outcomes.
- Diagnostic errors in infectious diseases pose a significant challenge in clinical practice.
Purpose of the Study:
- To investigate common diagnostic errors in infectious diseases.
- To identify the causes of these diagnostic errors based on physician reports.
Main Methods:
- A survey was conducted among specialist physicians and residents in Mashhad, Iran, from August 2018 to February 2019.
- Participants reported diagnosed infectious disease errors they had made or witnessed.
Main Results:
- 465 cases were reported, with upper respiratory tract infections (URTIs), tuberculosis (TB), and pleuropulmonary infections being most affected by diagnostic errors.
- Errors most commonly occurred during diagnostic hypothesis generation (55.7%), history taking (43%), and physical examination (41.1%).
- Diagnostic errors for TB and intra-abdominal infections were associated with more severe patient outcomes.
Conclusions:
- Diagnostic errors in infectious diseases substantially affect patient outcomes.
- URTIs, TB, and pleuropulmonary infections are frequently involved in diagnostic errors.
- Consideration of contagious and life-threatening diseases in differential diagnoses is crucial for improving patient safety.
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