Related Experiment Video

Updated: Jul 17, 2026

Metagenomic Next-Generation Sequencing of Cerebrospinal Fluid for the Detection of Central Nervous System Pathogens
10:08

Metagenomic Next-Generation Sequencing of Cerebrospinal Fluid for the Detection of Central Nervous System Pathogens

Published on: April 17, 2026

Epidemiology of Potential Missed Diagnosis of Pediatric Central Nervous System Infections in the Emergency Department

Kaileen Jafari1,2, Yasaman Fatemi1,3, Apeksha Gupta1

  • 1Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, WA.

Pediatric Emergency Care
|July 16, 2026
PubMed

Insights

One in 10 children with CNS infections (CNSi) experienced a potential missed diagnosis, often after an emergency department visit for flu-like symptoms. This risk was higher in older infants and children, and in those treated at lower-volume or non-academic emergency departments.

Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Emergency Medicine

Background:

  • Pediatric central nervous system infections (CNSi) are uncommon but serious conditions requiring prompt diagnosis.
  • Timely emergency department (ED) diagnosis of CNSi is critical but challenging.
  • This study investigated the epidemiology of potential missed diagnoses (PMD) of CNSi and their link to neurological complications.

Purpose of the Study:

  • To characterize the epidemiology of potential missed diagnoses (PMD) in pediatric CNS infections (CNSi).
  • To assess the association between PMD of CNSi and acute neurological complications.
  • To identify risk factors for PMD in pediatric CNSi.

Main Methods:

  • A cross-sectional analysis of 2018-2019 healthcare data from five US states.
  • Included children aged 0-17 years admitted for CNSi, excluding specific cases.
  • Defined PMD using a prior 7-day ED visit with a high-risk diagnosis and employed logistic regression.

Main Results:

  • 10.6% of pediatric CNSi cases had a PMD, with a median revisit interval of 2 days.
  • PMD was more common in children over 90 days old, minority racial/ethnic groups, and those treated at lower-volume or non-teaching EDs.
  • Among bacterial CNSi cases, PMD was linked to a significantly increased risk of neurological complications (aOR 2.49).

Conclusions:

  • A substantial proportion of pediatric CNSi cases involve a potential missed diagnosis, frequently following an initial ED visit for nonspecific symptoms.
  • Children over 90 days old and those presenting to less specialized EDs face a higher risk of PMD.
  • Improving diagnostic tools for pediatric CNS infections is crucial, especially for older infants and children, to prevent severe neurological outcomes.
Abstract

Keywords:
diagnostic errorhealth servicesinfectious diseaseneurology

Related Concept Videos

Encephalitis l: Introduction01:19

Encephalitis l: Introduction

Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...
Documentation of Nursing Diagnosis01:10

Documentation of Nursing Diagnosis

The nurse documents nursing diagnoses and enters them into the patient record. The identified patient's nursing diagnosis is either written out with a plan of care or entered into the electronic health record.
In some settings, data-driven computerized decision support systems are in place, allowing for more accurate nursing diagnoses. The database within one of these systems includes diagnostic labels defining characteristics, activities, and indicators for nursing. A nurse enters assessment...
Encephalitis ll: Pathophysiology01:26

Encephalitis ll: Pathophysiology

Encephalitis is inflammation of the brain parenchyma caused by direct viral invasion or immune-mediated mechanisms triggered by infections or tumors. Both processes lead to neuronal injury, disrupted neurotransmission, and diverse neurological symptoms, often with overlapping clinical and pathological features.Autoimmune EncephalitisIn autoimmune encephalitis, antibodies target neuronal antigens on cell surfaces, synapses, or within neurons. A key example is anti-NMDAR encephalitis, which can...
Viral Meningitis01:18

Viral Meningitis

Viral meningitis is the most common form of meningitis and is often referred to as aseptic meningitis to indicate the absence of bacterial involvement. It is generally milder than bacterial meningitis, with symptoms including fever, headache, stiff neck, drowsiness, nausea, photophobia, and vomiting. Rarely, more severe manifestations or death may occur. Common causative agents include enteroviruses, particularly coxsackie A and B viruses and echoviruses, all members of the Enterovirus genus...
Brain Abscess l: Introduction01:26

Brain Abscess l: Introduction

A brain abscess is a focal, intracerebral infection characterized by a localized collection of pus within the brain parenchyma, resulting from microbial invasion and the body’s inflammatory response. It progresses through stages: early and late cerebritis, followed by early and late capsule formation, reflecting tissue destruction, immune response, and eventual encapsulation.Etiology and PathogenesisCausative organisms vary with source and host factors, often involving polymicrobial infections,...
Pneumonia III: Complications and Assessment01:30

Pneumonia III: Complications and Assessment

Pneumonia poses the potential for numerous complications that warrant consideration. These complications include the following: