Diagnostic errors in acute cholecystitis: a scoping review

Diagnostic errors in acute cholecystitis significantly impact patient safety. Misdiagnosis, including both false negatives and false positives, is common due to the complex nature of abdominal pain and the overlapping symptoms of various conditions. This scoping review examines the definition, prevalence, and contributing factors of diagnostic errors in acute cholecystitis, emphasizing the need for improved diagnostic processes.

Employing the PRISMA-ScR framework, this review examined definitions and factors contributing to diagnostic errors in cholecystitis. It highlights the variability in diagnostic criteria, with many studies relying on clinical judgment rather than standardized guidelines such as the Tokyo Guidelines. False negative diagnoses are often due to hypoalbuminemia, inconspicuous imaging findings, and the clinical setting, whereas false positives often result from misinterpreted imaging findings and failure to differentiate from other conditions.

This review found that approximately 30 % of acute cholecystitis cases may be missed (false negative), and 20-36 % of cases initially diagnosed can be incorrect (false positive). Adherence to standardized guidelines and improved recognition of atypical presentations could reduce diagnostic errors.

Future research should aim for large-scale studies with clear diagnostic criteria and detailed clinical data to enhance diagnostic accuracy and patient safety.