@article{2260,
  author = {Maria Caridad Davalos and Kenya Samuels and Ashley N D Meyer and Satid Thammasitboon and Moushumi Sur and Kevin Roy and Aymer Al-Mutairi and Hardeep Singh},
  title = {Finding diagnostic errors in children admitted to the PICU},
  abstract = {<p><b>OBJECTIVES: </b>To determine whether the Safer Dx Instrument, a structured tool for finding diagnostic errors in primary care, can be used to reliably detect diagnostic errors in patients admitted to a PICU.</p><p><b>DESIGN AND SETTING: </b>The Safer Dx Instrument consists of 11 questions to evaluate the diagnostic process and a final question to determine if diagnostic error occurred. We used the instrument to analyze four "high-risk" patient cohorts admitted to the PICU between June 2013 and December 2013.</p><p><b>PATIENTS: </b>High-risk cohorts were defined as cohort 1: patients who were autopsied; cohort 2: patients seen as outpatients within 2 weeks prior to PICU admission; cohort 3: patients transferred to PICU unexpectedly from an acute care floor after a rapid response and requiring vasoactive medications and/or endotracheal intubation due to decompensation within 24 hours; and cohort 4: patients transferred to PICU unexpectedly from an acute care floor after a rapid response without subsequent decompensation in 24 hours.</p><p><b>INTERVENTIONS: </b>Two clinicians used the instrument to independently review records in each cohort for diagnostic errors, defined as missed opportunities to make a correct or timely diagnosis. Errors were confirmed by senior expert clinicians.</p><p><b>MEASUREMENTS AND MAIN RESULTS: </b>Diagnostic errors were present in 26 of 214 high-risk patient records (12.1%; 95% CI, 8.2-17.5%) with the following frequency distribution: cohort 1: two of 16 (12.5%); cohort 2: one of 41 (2.4%); cohort 3: 13 of 44 (29.5%); and cohort 4: 10 of 113 (8.8%). Overall initial reviewer agreement was 93.6% (κ, 0.72). Infections and neurologic conditions were the most commonly missed diagnoses across all high-risk cohorts (16/26).</p><p><b>CONCLUSIONS: </b>The Safer Dx Instrument has high reliability and validity for diagnostic error detection when used in high-risk pediatric care settings. With further validation in additional clinical settings, it could be useful to enhance learning and feedback about diagnostic safety in children.</p>},
  year = {2017},
  journal = {Pediatr Crit Care Med},
  volume = {18},
  pages = {265-271},
  month = {03/2017},
  issn = {1529-7535},
  doi = {10.1097/PCC.0000000000001059},
  language = {eng},
}