在解剖时使用错误代码来研究诊断错误中的潜在偏差
Bruce I Goldman1, Rajnish Bharadwaj1, Michelle Fuller1
1Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
Diagnosis (Berlin, Germany)
|October 4, 2023
概括
随着时间的推移,解剖诊断错误率 (DE) 增加. 女性病例最初显示出更多的DE,而后期显示出男性的未经记录的恶性瘤和非白人个体的更高的错误率,这表明潜在的偏见.
科学领域:
- 法医病理学 法医病理学
- 医学诊断 医学诊断 医学诊断
- 健康差异 在健康上的差异
背景情况:
- 目前的尸检指南缺乏识别诊断错误 (DE) 原因的方法.
- 尸检数据注册表可以被利用来调查影响DE的因素.
研究的目的:
- 确定性别和种族是否与解剖期间发现的诊断错误的频率有关.
- 分析诊断错误编码的趋势,并识别潜在的偏差.
主要方法:
- 使用了2012-2019年的尸检报告,使用ICD-9/ICD-10编码用于诊断和特定错误类型 (UNDOC,UNCON).
- 评估了与性别和种族相关的DE成人尸检病例,比较了2012-2015年和2015-2019年期间的数据.
- 分析了DE频率观察到的差异的统计学意义.
主要成果:
- 整体DE频率从65.9% (2012-2015年) 增加到72.1% (2015-2019年).
- 从2012年至2015年,女性病例的DE频率 (总错误,UNDOC,UNCON) 较高 (p<0.0001).
- 从2015年到2019年,未经记录的恶性瘤在男性中更高 (p=0.0065),非白人受试者有更高的未经证实的死亡原因和整体错误比例 (p<0.0003).
结论:
- 解剖诊断错误编码可以揭示与性别和种族有关的潜在偏见.
- 对DE的系统编码为诊断准确性和潜在差异提供了宝贵的见解.
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