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Types of diagnostic errors reported by paediatric emergency providers in a global paediatric emergency care research
Prashant Mahajan1, Joseph A Grubenhoff2, Jim Cranford3
1Emergency Medicine and Paediatrics, University of Michigan, Ann Arbor, Michigan, USA pmahajan@med.umich.edu.
Background:
Diagnostic errors, reframed as missed opportunities for improving diagnosis (MOIDs), are poorly understood in the paediatric emergency department (ED) setting. We investigated the clinical experience, harm and contributing factors related to MOIDs reported by physicians working in paediatric EDs.
Methods:
We developed a web-based survey in which physicians participating in the international Paediatric Emergency Research Network representing five out of six WHO regions, described examples of MOIDs involving their own or a colleague's patients. Respondents provided case summaries and answered questions regarding harm and factors contributing to the event.
Results:
Of 1594 physicians surveyed, 412 (25.8%) responded (mean age=43 years (SD=9.2), 42.0% female, mean years in practice=12 (SD=9.0)). Patient presentations involving MOIDs had common undifferentiated symptoms at initial presentation, including abdominal pain (21.1%), fever (17.2%) and vomiting (16.5%). Patients were discharged from the ED with commonly reported diagnoses, including acute gastroenteritis (16.7%), viral syndrome (10.2%) and constipation (7.0%). Most reported MOIDs (65%) were detected on ED return visits (46% within 24 hours and 76% within 72 hours). The most common reported MOID was appendicitis (11.4%), followed by brain tumour (4.4%), meningitis (4.4%) and non-accidental trauma (4.1%). More than half (59.1%) of the reported MOIDs involved the patient/parent-provider encounter (eg, misinterpreted/ignored history or an incomplete/inadequate physical examination). Types of MOIDs and contributing factors did not differ significantly between countries. More than half of patients had either moderate (48.7%) or major (10%) harm due to the MOID.
Conclusions:
An international cohort of paediatric ED physicians reported several MOIDs, often in children who presented to the ED with common undifferentiated symptoms. Many of these were related to patient/parent-provider interaction factors such as suboptimal history and physical examination. Physicians' personal experiences offer an underexplored source for investigating and mitigating diagnostic errors in the paediatric ED.
Insights
Missed opportunities for improving diagnosis (MOIDs) in paediatric emergency departments often involve common symptoms and patient-provider interactions. Many MOIDs are detected upon patient return visits, leading to significant harm.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Error Research
- Patient Safety
Background:
- Diagnostic errors, termed missed opportunities for improving diagnosis (MOIDs), are not well understood in pediatric emergency departments (EDs).
- Physicians' experiences with MOIDs in pediatric EDs are an under-explored area for improving diagnostic accuracy.
Purpose of the Study:
- To investigate the clinical experience, harm, and contributing factors of MOIDs reported by physicians in pediatric EDs.
- To identify common presentations and diagnoses associated with MOIDs in children.
Main Methods:
- A web-based survey was distributed to physicians in the international Paediatric Emergency Research Network across five WHO regions.
- Physicians described MOID cases involving their patients or colleagues, detailing harm and contributing factors.
Main Results:
- Appendicitis was the most common missed diagnosis, followed by brain tumor and meningitis.
- Common presenting symptoms included abdominal pain, fever, and vomiting, often leading to initial diagnoses of gastroenteritis or viral syndrome.
- Over half of MOIDs involved patient/parent-provider encounters, such as misinterpreted history or inadequate physical exams, with significant patient harm reported.
Conclusions:
- MOIDs in pediatric EDs frequently occur in children with common, undifferentiated symptoms.
- Patient-provider interaction factors significantly contribute to MOIDs, highlighting the need for improved history taking and physical examinations.
- Physician-reported experiences are a valuable resource for understanding and mitigating diagnostic errors in pediatric emergency care.
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