Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar;12(1):e002062.
doi: 10.1136/bmjoq-2022-002062.

Types of diagnostic errors reported by paediatric emergency providers in a global paediatric emergency care research network

Prashant Mahajan  1 , Joseph A Grubenhoff  2 , Jim Cranford  3 , Maala Bhatt  4 , James M Chamberlain  5 , Todd Chang  6 , Mark Lyttle  7 , Rianne Oostenbrink  8 , Damian Roland  9 , Richard M Rudy  10 , Kathy N Shaw  11 , Robert Velasco Zuniga  12 , Apoorva Belle  3 , Nathan Kuppermann  13 , Hardeep Singh  14
Affiliations

Types of diagnostic errors reported by paediatric emergency providers in a global paediatric emergency care research network

Prashant Mahajan et al. BMJ Open Qual. 2023 Mar.

Abstract

Background: Diagnostic errors, reframed as missed opportunities for improving diagnosis (MOIDs), are poorly understood in the paediatric emergency department (ED) setting. We investigated the clinical experience, harm and contributing factors related to MOIDs reported by physicians working in paediatric EDs.

Methods: We developed a web-based survey in which physicians participating in the international Paediatric Emergency Research Network representing five out of six WHO regions, described examples of MOIDs involving their own or a colleague's patients. Respondents provided case summaries and answered questions regarding harm and factors contributing to the event.

Results: Of 1594 physicians surveyed, 412 (25.8%) responded (mean age=43 years (SD=9.2), 42.0% female, mean years in practice=12 (SD=9.0)). Patient presentations involving MOIDs had common undifferentiated symptoms at initial presentation, including abdominal pain (21.1%), fever (17.2%) and vomiting (16.5%). Patients were discharged from the ED with commonly reported diagnoses, including acute gastroenteritis (16.7%), viral syndrome (10.2%) and constipation (7.0%). Most reported MOIDs (65%) were detected on ED return visits (46% within 24 hours and 76% within 72 hours). The most common reported MOID was appendicitis (11.4%), followed by brain tumour (4.4%), meningitis (4.4%) and non-accidental trauma (4.1%). More than half (59.1%) of the reported MOIDs involved the patient/parent-provider encounter (eg, misinterpreted/ignored history or an incomplete/inadequate physical examination). Types of MOIDs and contributing factors did not differ significantly between countries. More than half of patients had either moderate (48.7%) or major (10%) harm due to the MOID.

Conclusions: An international cohort of paediatric ED physicians reported several MOIDs, often in children who presented to the ED with common undifferentiated symptoms. Many of these were related to patient/parent-provider interaction factors such as suboptimal history and physical examination. Physicians' personal experiences offer an underexplored source for investigating and mitigating diagnostic errors in the paediatric ED.

Keywords: diagnostic errors; emergency department; paediatrics.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
MOIDs study recruitment flow chart. MOIDs, missed opportunities for improving diagnosis; PERN, Paediatric Emergency Research Network; PECARN, Paediatric Emergency Care Applied Research Network; PEM-CRC, Paediatric Emergency Medicine Collaborative Research Committee; PERC, Paediatric Emergency Research Canada; PERUKI, Paediatric Emergency Research in the United Kingdom and Ireland; RISeuP/SPERG, Red de Investigación de la Sociedad Española de Urgencias de Pediatría/Spanish Paediatric Emergency Research Group; REPEM, Research in European Paediatric Emergency Medicine.
See this image and copyright information in PMC

References

    1. Croskerry P, Sinclair D. Emergency medicine: a practice prone to error? CJEM 2001;3:271–6. 10.1017/s1481803500005765 - DOI - PubMed
    1. Institute of Medicine . Improving diagnosis in health care. Washington, DC: National Academies of Sciences, Engineering, and Medicine, 2015. Available: http://iom.nationalacademies.org/Reports/2015/Improving-Diagnosis-in-Hea...
    1. Singh H, Meyer AND, Thomas EJ. The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving us adult populations. BMJ Qual Saf 2014;23:727–31. 10.1136/bmjqs-2013-002627 - DOI - PMC - PubMed
    1. Wier LM, Hao Y, Owens P, et al. . Overview of children in the emergency department, 2010 HCUP statistical brief #157. Rockville, MD: Agency for Healthcare Research and Quality, 2013. Available: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb157.pdf - PubMed
    1. Kassirer JP, Kopelman RI. Cognitive errors in diagnosis: instantiation, classification, and consequences. Am J Med 1989;86:433–41. 10.1016/0002-9343(89)90342-2 - DOI - PubMed