دورية أكاديمية
Prevalence and Characteristics of Diagnostic Error in Pediatric Critical Care: A Multicenter Study.
| العنوان: | Prevalence and Characteristics of Diagnostic Error in Pediatric Critical Care: A Multicenter Study. |
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| المؤلفون: | Cifra CL; Division of Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA.; Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA., Custer JW; Division of Critical Care, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD., Smith CM; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL., Smith KA; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI., Bagdure DN; Department of Pediatrics, Louisiana State University Health Shreveport School of Medicine, Shreveport, LA., Bloxham J; University of Iowa College of Nursing, Iowa City, IA., Goldhar E; Pediatric Intensive Care Unit, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL., Gorga SM; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI., Hoppe EM; Pediatric Intensive Care Unit, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL., Miller CD; Department of Pediatrics, Section of Critical Care, University of Colorado School of Medicine, Aurora, CO., Pizzo M; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI.; University of Michigan School of Nursing, Ann Arbor, MI., Ramesh S; Department of Pediatrics, BronxCare Health System, New York, NY., Riffe J; Department of Pediatrics, Family First Health, York, PA., Robb K; Division of Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA., Simone SL; University of Maryland School of Nursing, Baltimore, MD., Stoll HD; University of Iowa College of Nursing, Iowa City, IA., Tumulty JA; Pediatric Intensive Care Unit, University of Maryland Children's Hospital, Baltimore, MD., Wall SE; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI.; University of Michigan School of Nursing, Ann Arbor, MI., Wolfe KK; Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO., Wendt L; University of Iowa Institute for Clinical and Translational Science, Iowa City, IA., Ten Eyck P; University of Iowa Institute for Clinical and Translational Science, Iowa City, IA.; Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA., Landrigan CP; Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA., Dawson JD; Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA., Reisinger HS; University of Iowa Institute for Clinical and Translational Science, Iowa City, IA.; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.; Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, IA., Singh H; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX., Herwaldt LA; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA. |
| المصدر: | Critical care medicine [Crit Care Med] 2023 Nov 01; Vol. 51 (11), pp. 1492-1501. Date of Electronic Publication: 2023 May 30. |
| نوع المنشور: | Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.; Research Support, N.I.H., Extramural |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0355501 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1530-0293 (Electronic) Linking ISSN: 00903493 NLM ISO Abbreviation: Crit Care Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Philadelphia, PA : Lippincott Williams & Wilkins Original Publication: New York, Kolen. |
| مواضيع طبية MeSH: | Critical Illness*/epidemiology , Intensive Care Units, Pediatric*, Adolescent ; Child ; Child, Preschool ; Humans ; Infant ; Infant, Newborn ; Critical Care ; Diagnostic Errors ; Prevalence ; Retrospective Studies |
| مستخلص: | 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. Competing Interests: Drs. Cifra, Smith, Riffe, Landrigan, and Dawson’s institutions received funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development through a K12 grant to the University of Iowa Stead Family Department of Pediatrics (no. HD027748-28) and the National Center for Advancing Translational Sciences. Drs. Cifra, KA Smith, Riffe, Landrigan, Dawson, and Herwaldt’s institutions received funding from the Agency for Healthcare Research and Quality (AHRQ) through a K08 grant (no. HS026965). This work was further supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (no. UL1TR002537) through the University of Iowa’s Institute for Clinical and Translational Science. Dr. Cifra received funding from the AHRQ, MedStar Research Institute, and De Gruyter. Drs. Cifra, CM Smith, KA Smith, Riffe, Ten Eyck, Landrigan, and Dawson received support for article research from the National Institutes of Health. Drs. Custer and Tumulty’s institution received funding from University of Iowa. Dr. Miller’s institution received funding from the University of Iowa Department of Pediatrics. Dr. Landrigan received funding from I-PASS Institute and Missouri Hospital Association Executive Speakers Bureau. Dr. Singh is funded in part by the Houston Veterans Administration (VA) Health Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness, and Safety (CIN13–413), the VA HSR&D Service (IIR17–127 and the Presidential Early Career Award for Scientists and Engineers USA 14–274), the VA National Center for Patient Safety, the Agency for Healthcare Research and Quality (R01HS27363), and the Gordon and Betty Moore Foundation. He disclosed government work. Dr. Herwaldt’s institution received funding from the Centers for Disease Control and Prevention; she disclosed that Professional Disposables International, Inc. (PDI) is providing a product for a clinical trial. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.) |
| التعليقات: | Comment in: Crit Care Med. 2023 Nov 1;51(11):1597-1599. (PMID: 37902345) |
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| معلومات مُعتمدة: | UL1 TR002537 United States TR NCATS NIH HHS; K12 HD027748 United States HD NICHD NIH HHS; K08 HS026965 United States HS AHRQ HHS; R01 HS027363 United States HS AHRQ HHS; U54 TR001356 United States TR NCATS NIH HHS |
| تواريخ الأحداث: | Date Created: 20230529 Date Completed: 20231101 Latest Revision: 20240210 |
| رمز التحديث: | 20240210 |
| مُعرف محوري في PubMed: | PMC10615661 |
| DOI: | 10.1097/CCM.0000000000005942 |
| PMID: | 37246919 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1530-0293 |
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| DOI: | 10.1097/CCM.0000000000005942 |