Language
English
Publication Date
11-1-2023
Journal
Critical Care Medicine
DOI
10.1097/CCM.0000000000005942
PMID
37246919
PMCID
PMC10615661
PubMedCentral® Posted Date
11-1-2024
PubMedCentral® Full Text Version
Author MSS
Abstract
Objectives: Effective interventions to prevent diagnostic error among critically ill children should be informed by diagnostic error prevalence and etiologies. We aimed to determine the prevalence and characteristics of diagnostic errors and identify factors associated with error in patients admitted to the PICU.
Design: Multicenter retrospective cohort study using structured medical record review by trained clinicians using the Revised Safer Dx instrument to identify diagnostic error (defined as missed opportunities in diagnosis). Cases with potential errors were further reviewed by four pediatric intensivists who made final consensus determinations of diagnostic error occurrence. Demographic, clinical, clinician, and encounter data were also collected.
Setting: Four academic tertiary-referral PICUs.
Patients: Eight hundred eighty-two randomly selected patients 0-18 years old who were nonelectively admitted to participating PICUs.
Interventions: None.
Measurements and main results: Of 882 patient admissions, 13 (1.5%) had a diagnostic error up to 7 days after PICU admission. Infections (46%) and respiratory conditions (23%) were the most common missed diagnoses. One diagnostic error caused harm with a prolonged hospital stay. Common missed diagnostic opportunities included failure to consider the diagnosis despite a suggestive history (69%) and failure to broaden diagnostic testing (69%). Unadjusted analysis identified more diagnostic errors in patients with atypical presentations (23.1% vs 3.6%, p = 0.011), neurologic chief complaints (46.2% vs 18.8%, p = 0.024), admitting intensivists greater than or equal to 45 years old (92.3% vs 65.1%, p = 0.042), admitting intensivists with more service weeks/year (mean 12.8 vs 10.9 wk, p = 0.031), and diagnostic uncertainty on admission (77% vs 25.1%, p < 0.001). Generalized linear mixed models determined that atypical presentation (odds ratio [OR] 4.58; 95% CI, 0.94-17.1) and diagnostic uncertainty on admission (OR 9.67; 95% CI, 2.86-44.0) were significantly associated with diagnostic error.
Conclusions: 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, suggesting possible targets for intervention.
Keywords
Adolescent, Child, Child, Preschool, Humans, Infant, Infant, Newborn, Critical Care, Critical Illness, Diagnostic Errors, Intensive Care Units, Pediatric, Prevalence, Retrospective Studies
Published Open-Access
yes
Recommended Citation
Cifra, Christina L; Custer, Jason W; Smith, Craig M; et al., "Prevalence and Characteristics of Diagnostic Error in Pediatric Critical Care: A Multicenter Study" (2023). Faculty and Staff Publications. 4552.
https://digitalcommons.library.tmc.edu/baylor_docs/4552