Pediatric anesthesia & critical care
Prevalence and Characteristics of Diagnostic Error in Pediatric Critical Care: A Multicenter Study*
Authors' conclusion
Among critically ill children, 1.5% had a diagnostic error up to 7 days after PICU admission. Diagnostic errors were associated with atypical presentations and diagnostic uncertainty on admission
Study context
- Population
- Children 0–18 years nonelectively admitted to four academic tertiary-referral PICUs, randomly selectedrandomly selected
- Participants
- 882 children
- Outcome
- Prevalence and characteristics of diagnostic errors in PICU admissions
- Follow-up
- Up to 7 days after PICU admission
Methodological detailsmulticentre, structured medical record review (Revised Safer Dx instrument), consensus determination by four pediatric intensivists
- Multicentre
- Structured medical record review (Revised Safer Dx instrument)
- Consensus determination by four pediatric intensivists
Main finding
As reported in the abstract
Diagnostic error
Admissions with a diagnostic error
13
1.5%
Observational data: associations, not effects.
Further findings
Factors associated with diagnostic error (generalized linear mixed models)
| OR (95% CI) | ||
|---|---|---|
| Atypical presentation | 4.58 (0.94–17.1) | |
| Diagnostic uncertainty on admission | 9.67 (2.86–44.0) | |
| 0.050.21520Odds ratio (log scale) |
- Factors associated with diagnostic error (generalized linear mixed models): reported by the authors as significantly associated with diagnostic error
Most common missed diagnoses
- Infections
- 46%
- Respiratory conditions
- 23%
Common missed diagnostic opportunities
- Failure to consider the diagnosis despite a suggestive history
- 69%
- Failure to broaden diagnostic testing
- 69%
Factors associated with diagnostic error (unadjusted, error vs no error)
- Atypical presentation
- 23.1% vs 3.6%, p = 0.011
- Neurologic chief complaint
- 46.2% vs 18.8%, p = 0.024
- Admitting intensivist ≥45 years old
- 92.3% vs 65.1%, p = 0.042
- Admitting intensivist service weeks/year (mean)
- 12.8 vs 10.9 wk, p = 0.031
- Diagnostic uncertainty on admission
- 77% vs 25.1%, p < 0.001
- Unadjusted analysis
Safety
Harm from diagnostic error
- Diagnostic error causing harm (prolonged hospital stay)
- 1
Original publication
Prevalence and Characteristics of Diagnostic Error in Pediatric Critical Care: A Multicenter Study*. Crit Care Med. Published 30 May 2023. doi:10.
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