Diagnostic error in the pediatric hospital: a narrative review

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ABSTRACT

Introduction

Diagnostic error is a prevalent type of medical error that is associated with considerable patient harm and increased medical costs. The majority of literature guiding the current understanding of diagnostic error in the hospital setting is from adult studies. However, there is research to suggest this type of error is also prevalent in the pediatric specialty.

Objectives

The primary objective of this study was to define the current understanding of diagnostic error in the pediatric hospital through a structured literature review.

Methods

We searched PubMed and identified studies focusing on three aspects of diagnostic error in pediatric hospitals: the incidence or prevalence, contributing factors, and related interventions. We used a tiered review, and a standardized electronic form to extract data from included articles.

Results

Fifty-nine abstracts were screened and 23 full-text studies were included in the final review. Seventeen of the 23 studies focused on the incidence or prevalence, with only 3 studies investigating the utility of interventions. Most studies took place in an intensive care unit or emergency department with very few studies including only patients on the general wards. Overall, the prevalence of diagnostic error in pediatric hospitals varied greatly and depended on the measurement technique and specific hospital setting. Both healthcare system factors and individual cognitive factors were found to contribute to diagnostic error, with there being limited evidence to guide how best to mitigate the influence of these factors on the diagnostic process.

Conclusion

The general knowledge of diagnostic error in pediatric hospital settings is limited. Future work should incorporate structured frameworks to measure diagnostic errors and examine clinicians’ diagnostic processes in real-time to help guide effective hospital-wide interventions.

KEYWORDS:

• Diagnostic error
• diagnosis
• misdiagnosis
• patient safety
• hospital medicine
• critical care
• emergency department
• pediatrics

Acknowledgments

The authors would like to thank Elizabeth T. Frakes, MSIS, for assistance in conducting the literature search.

Declaration of interest

The author(s) have no relevant conflicts of interest to disclose.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The research reported in this publication was supported (in part or in full) by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number [UL1TR002538]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.