Diagnostic errors in abdominal pain: a secondary analysis of case reports

Diagnostic errors remain common in abdominal pain, a frequent yet challenging presentation. We sought to compare diagnostic error profiles between abdominal and non-abdominal pain and to identify abdominal pain-specific, potentially modifiable targets in physical examination, diagnostic testing, and differential diagnosis.

We conducted a retrospective secondary analysis of a systematically coded database of diagnostic error case reports. Adult pain cases were categorized as abdominal or non-abdominal after excluding pediatric and non-pain cases. Errors were classified using the Diagnostic Error Evaluation and Research (DEER), Reliable Diagnosis Challenges (RDC), and Generic Diagnostic Pitfalls (GDP) taxonomies. Frequencies of codes and contributing factors were compared.

Of 163 cases, 55 involved abdominal pain and 108 non-abdominal pain. The abdominal pain group had more RDC codes per case (3.1 ± 1.8 vs. 2.5 ± 1.7; p=0.032). Misinterpretation of physical findings and diagnostic tests, particularly imaging, was more common. Presentations with non-specific features or findings that masked/mimicked other conditions were also more frequent. Most physical examination errors (78 %) and imaging errors (82 %) reflected misinterpretation rather than underordering.

Diagnostic errors in abdominal pain often involve misinterpreting physical and imaging findings and difficulty distinguishing among diseases within the correct organ system. Strengthening bedside diagnostic skills, fostering structured comparison of same-organ differential diagnoses, and ensuring reliable radiology support may reduce these errors and enhance patient safety.