@article{4364,
  keywords = {cognitive bias, diagnostic error, paediatrics},
  author = {Catherine Warrick and Poonam Patel and Warren Hyer and Graham Neale and Nick Sevdalis and David Inwald},
  title = {Diagnostic error in children presenting with acute medical illness to a community hospital.},
  abstract = {<p><b>OBJECTIVE: </b>To determine incidence and aetiology of diagnostic errors in children presenting with acute medical illness to a community hospital.</p><p><b>DESIGN: </b>A three-stage study was conducted. Stage 1: retrospective case note review, comparing admission to discharge diagnoses of children admitted to hospital, to determine incidence of diagnostic error. Stage 2: cases of suspected misdiagnosis were examined in detail by two reviewers. Stage 3: structured interviews were conducted with clinicians involved in these cases to identify contributory factors.</p><p><b>SETTING: </b>UK community (District General) hospital.</p><p><b>PARTICIPANTS: </b>All medical patients admitted to the paediatric ward and patients transferred from the Emergency Department to a different facility over a 90-day period were included.</p><p><b>MAIN OUTCOME MEASURES: </b>Incidence of diagnostic error, type of diagnostic error and content analysis of the structured interviews to determine frequency of emerging themes.</p><p><b>RESULTS: </b>Incidence of misdiagnosis in children presenting with acute illness was 5.0% (19/378, 95% confidence interval (CI) 2.8-7.2%). Diagnostic errors were multi-factorial in origin, commonly involving cognitive factors. Reviewers 1 and 2 identified a median of three and four errors per case, respectively. In 14 cases, structured interviews were possible; clinicians believed system-related errors (organizational flaws, e.g. inadequate policies, staffing or equipment) contributed more commonly to misdiagnoses, whereas reviewers found cognitive factors contributed more commonly to diagnostic error.</p><p><b>CONCLUSIONS: </b>Misdiagnoses occurred in 5% of children presenting with acute illness and were multi-factorial in aetiology. Multi-site longitudinal studies further exploring aetiology of errors and effect of educational interventions are required to generalize these findings and determine strategies for mitigation.</p>},
  year = {2014},
  journal = {Int J Qual Health Care},
  volume = {26},
  pages = {538-46},
  month = {10/2014},
  issn = {1464-3677},
  doi = {10.1093/intqhc/mzu066},
  language = {eng},
}