Background: Diagnostic error is commonly defined as a missed, delayed or wrong diagnosis and has been described as among the most important patient safety hazards. Diagnostic errors also account for the largest category of medical malpractice high severity claims and total payouts. Despite a large literature on the incidence of inpatient adverse events, no systematic review has attempted to estimate the prevalence and nature of harmful diagnostic errors in hospitalised patients.
Methods: A systematic literature search was conducted using Medline, Embase, Web of Science and the Cochrane library from database inception through 9 July 2019. We included all studies of hospitalised adult patients that used physician review of case series of admissions and reported the frequency of diagnostic adverse events. Two reviewers independently screened studies for inclusion, extracted study characteristics and assessed risk of bias. Harmful diagnostic error rates were pooled using random-effects meta-analysis.
Results: Twenty-two studies including 80 026 patients and 760 harmful diagnostic errors from consecutive or randomly selected cohorts were pooled. The pooled rate was 0.7% (95% CI 0.5% to 1.1%). Of the 136 diagnostic errors that were described in detail, a wide range of diseases were missed, the most common being malignancy (n=15, 11%) and pulmonary embolism (n=13, 9.6%). In the USA, these estimates correspond to approximately 249 900 harmful diagnostic errors yearly.
Conclusion: Based on physician review, at least 0.7% of adult admissions involve a harmful diagnostic error. A wide range of diseases are missed, including many common diseases. Fourteen diagnoses account for more than half of all diagnostic errors. The finding that a wide range of common diagnoses are missed implies that efforts to improve diagnosis must target the basic processes of diagnosis, including both cognitive and system-related factors.
Prospero Registration Number: CRD42018115186.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1136/bmjqs-2019-010822 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Blind nasoenteric tube placement risks: A case report of misplacement into the pleural cavity.
Medicine (Baltimore)
January 2025
Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People's Republic of China.
Rationale: Enteral nutrition is a critical component of care for critically ill patients. However, the blind insertion of a nasoenteric tube, despite being a simple procedure, carries inherent risks that necessitate a reevaluation of the technique.
Patient Concerns: A case of a 60-year-old female experienced the rare yet critical complication of a misplaced nasoenteric tube entering the thoracic cavity during a blind insertion procedure for enteral nutrition following a liver transplant.
Paraspinal synovial sarcoma mimicking tuberculosis: A case report and literature review.
Medicine (Baltimore)
January 2025
Department of Bone and Joint Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Rationale: Synovial sarcoma (SS) is a rare and highly malignant soft tissue sarcoma. When SS occurs in atypical locations, it can present significant diagnostic challenges. We report a case of paraspinal SS initially misdiagnosed as spinal tuberculosis, highlighting the diagnostic difficulties and the importance of considering SS in the differential diagnosis.
View Article and Find Full Text PDFMultiomics dissection of human RAG deficiency reveals distinctive patterns of immune dysregulation but a common inflammatory signature.
Sci Immunol
January 2025
Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
Human recombination-activating gene (RAG) deficiency can manifest with distinct clinical and immunological phenotypes. By applying a multiomics approach to a large group of -mutated patients, we aimed at characterizing the immunopathology associated with each phenotype. Although defective T and B cell development is common to all phenotypes, patients with hypomorphic variants can generate T and B cells with signatures of immune dysregulation and produce autoantibodies to a broad range of self-antigens, including type I interferons.
View Article and Find Full Text PDFThe use of the MK5 Mobility Classes to improve safe patient handling: a reliability study.
Br J Nurs
January 2025
Physiotherapist, AZ Alma Eeklo, Belgium.
In health care, work-related musculoskeletal disorders are largely attributed to patient-handling tasks. Reliable assessments of patient mobility are imperative to mitigate the musculoskeletal burden on healthcare providers. This study explores the reliability of MK5 Mobility Classes, a patient mobility classification system.
View Article and Find Full Text PDFComparison of Freestyle Optium Neo H and Centrivet GK Device in the Diagnosis of Hypoglycaemia and Hyperketonaemia in Dairy Goats: A Field Study.
Vet Med Sci
January 2025
Department of Statistics, Faculty of Science, University of Muğla Sıtkı Koçman, Muğla, Turkey.
Background: There is a lack of data on the validation and diagnostic performance of the Freestyle Optium Neo-H (Freestyle) and Centrivet GK (Centrivet) devices for the diagnosis of hypoglycaemia, hyperglycaemia and hyperketonaemia in goats.
Objectives: The aim of the present study was to validate the Freestyle and Centrivet for the analysis of whole blood beta-hydroxybutyric acid (BHBA) and to validate the Freestyle for the analysis of whole blood glucose concentrations using the reference method (RM) in goat blood collected from the jugular and ear veins.
Methods: Venous blood samples were utilised to assess glucose and BHBA concentrations using the Freestyle, Centrivet and RM.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!