Pediatricians report diagnostic error rates

Patient follow-ups and electronic medical records likely would help prevent misdiagnoses, the physicians said.

By — Posted July 13, 2010

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More than half of pediatricians who participated in a new study said they make diagnostic errors at least once or twice per month. And nearly half said they make diagnostic errors that caused harm to a patient at least once or twice per year.

The results, published online June 21 in Pediatrics, are believed to be part of the first study to look at diagnostic errors through a comprehensive survey.

Researchers hope that the findings enhance the understanding of diagnostic errors that affect children and serve as a guide to develop strategies to prevent such errors.

"I was excited because pediatricians seemed to be forthcoming in discussing it," said pediatrician and study co-author Geeta Singhal, MD, an assistant professor of pediatrics at Baylor College of Medicine in Texas.

The study's authors surveyed more than 700 academic-based pediatricians and community-based pediatricians at two sites in Houston and one in Cincinnati between November 2008 and May 2009.

The study "helped us pinpoint some of the areas to work on" concerning diagnostic errors, said Hardeep Singh, MD, MPH, an investigator with the Health Policy and Quality Program at the Houston Veterans Affairs Health Research and Development Center of Excellence.

Self-reported errors differ markedly from those mentioned in pediatric malpractice literature, the study showed. In those studies, meningitis, appendicitis, pneumonia and testicular torsion are cited as being missed most often.

But in the self-reported Pediatrics survey, physicians most frequently misdiagnosed viral illnesses as bacterial illnesses. Misdiagnosis of medication side effects, psychiatric disorders and appendicitis also were common (link).

Doctors said process breakdowns associated with diagnostic errors most often involved failure to gather available medical information through a patient history, physical examination or chart review. Inadequate care coordination and teamwork were the most commonly reported system problems contributing to errors.

Pediatricians said follow-ups of patients, access to electronic medical records and diagnostic decision-support tools would help prevent diagnostic errors.

"In contrast to previous literature, our findings may be more generalizable to routine practice and may provide concrete targets for future training and interventions to prevent diagnostic errors in children," the study said.

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