Diagnostic errors remain a major healthcare concern. This study was a retrospective record review of 882 pediatric intensive care unit (PICU) patients to identify diagnostic errors using the Revised Safer Dx tool. Diagnostic errors were found in 13 (1.5%) patients, most commonly associated with atypical presentation and diagnostic uncertainty at admission.

Missed diagnostic opportunities often involve multiple process breakdowns and can lead to serious avoidable patient harm. Based on a web-based survey of 1,594 emergency medicine physicians, missed diagnostic opportunities most frequently occur in children who present to the emergency department with undifferentiated symptoms (e.g., abdominal pain, fever, vomiting) and often involve issues related to the patient/parent-provider interaction, such as misinterpreting patient history or inadequate physical exam.

AHRQ's 2022 report Diagnostic Errors in the Emergency Department: A Systematic Review, which reported an estimated 7.4 million patients receive a misdiagnosis in the emergency department every year, garnered public, practitioner, and researcher attention. In this peer-reviewed commentary, the authors critique several components of the report. They also support AHRQ's recommended next steps, and further call for additional public and private funding opportunities to continue improving diagnostic accuracy in the emergency department.

Vulnerable populations, such as those with limited English proficiency, minoritized race or ethnicity, migrant populations, or patients qualifying for public insurance, may be at higher risk for adverse health events. In this review, researchers sought to identify frequency and causes of diagnostic error of vulnerable populations presenting to the emergency department with cardiovascular or cerebrovascular/neurological symptoms. Black patients presenting with cardiovascular symptoms had significantly higher odds of diagnostic error. Other demographic factors did not show similar associations, nor did studies of patients with cerebrovascular/neurological symptoms.

Racial and ethnic health disparities are receiving increased attention, and yet structural racism continues to negatively impact communities of color. This review identified only six papers studying the impact of structural racism on severe maternal morbidity (SMM). Despite heterogeneity in measures and outcomes, the studies all demonstrated a link between structural racism and SMM; additional research is required.

Understanding human causes of diagnostic errors can lead to more specific targeted, specific recommendations and interventions. Using three classification instruments, researchers examined a series of serious adverse events related to diagnostic errors in the emergency department. Most of the human errors were based on intended actions and could be classified as mistakes or violations. Errors were more frequently made during the assessment and testing phases of the diagnostic process.

Misdiagnosis in the emergency department (ED) can result in increased morbidity and mortality. This retrospective chart review of patients admitted from the ED to hospital explored the concordance of ED admission and hospital discharge diagnoses. Results show 21.77% of patients had discordant diagnoses; discordant diagnosis was associated with increased length of stay, mortality, and up-triage to ICU.

Building on prior research on missed myocardial infarction, this study used the SPADE approach to identify delays in sepsis diagnosis. Using claims data, researchers used a ‘look back’ analysis to identify treat-and-release emergency department (ED) visits in the month prior to sepsis hospitalizations and identify common diagnoses linked to downstream sepsis hospitalizations.

Missed or delayed diagnosis of sepsis can lead to serious patient harm. This study used a Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) “look-forward” analysis to measure potential misdiagnosis of sepsis in patients discharged from the emergency department (ED) with treat-and-release fluid and electrolyte disorders (FED) or altered mental status (AMS). FED and AMS were associated with a spike in sepsis hospitalizations in the 7-day period following the ED visit. The authors suggest SPADE could be used to compare sepsis diagnostic performance across institutions and regions; develop interventions for targeted subgroups; and update early warning systems for sepsis diagnosis.

Diagnostic errors continue to be a patient safety concern, including in pediatric critical care. This systematic review explored the prevalence, impact, and contributing factors to diagnostic errors in the pediatric intensive care unit (PICU). The most common diagnostic errors occurred in cardiovascular, infectious, congenital, and neurologic conditions; cognitive and systems factors were associated with diagnostic errors. Future research should focus on disease- and systems-level determinants. 

Imaging is an important tool in the pediatric emergency department to guide diagnosis and treatment. In this study, researchers analyzed more than 3.6 million emergency department visits for patients younger than 18 years to evaluate racial and ethnic differences in diagnostic imaging rates. One-third of visits by non-Hispanic white children included imaging, compared with 24% of visits by non-Hispanic Black and 26% of Hispanic children. Given the risks of both radiation exposure and missed diagnoses, strategies to mitigate these disparities must be investigated.

Diagnostic error is an ongoing patient safety challenge that can result in patient harm. This literature review identified a set of emergency department (ED)-focused electronic health record (EHR) triggers (e.g., death following ED visit, change in treating service after admission, unscheduled return to the ED resulting in admission) and non-EHR based signals (e.g., patient complaints, referral to risk management) with the potential to screen ED visits for diagnostic safety events.

The symptom-disease pair analysis of diagnostic error approach, or SPADE approach, measures diagnostic errors resulting in adverse events using two analytic pathways – the ‘look back’ analysis identifies symptoms associated with adverse events and identifies the symptom-specific harm rate per hospitalization and the ‘look forward’ analysis measures the disease-specific harm rate per symptomatic discharge. Using data from 2009 to 2017, this retrospective analysis looked at Emergency Department (ED) visits within 30 days of a hospitalization for acute myocardial infarction (AMI) to identify symptoms linked to probable missed diagnoses. Within 30 days of a subsequent hospitalization for AMI, common ED discharge diagnoses included chest pain and dyspnea, representing 574 probable missed AMIs. The authors estimate that these results correspond to approximately 10,000 potentially-preventable harms annually in the United States.  

Much of the evidence about preventable harm in patients with psychiatric illnesses is limited to inpatient psychiatric facilities. This case-control study explores patient-related factors that place patients at an increased risk for patient safety incidents in primary or emergency care. While differences in income, education, and foreign background had some association with preventable harm, researchers found that psychiatric illness nearly doubled the risk of preventable harm among both emergency and primary care patients, with nearly half (46%) of harm attributable to diagnostic errors.

The Joint Commission recognizes potential overuse of diagnostic imaging, particularly computed tomographic (CT) scans, to be a patient safety risk due to excess radiation exposure. This study sought to determine whether low-dose whole-body CT (WBCT), which exposes the patient to less radiation, has similar accuracy to standard-dose WBCT. A cohort of over 1,000 patients with suspected blunt trauma were prospectively recruited; half received standard-dose WBCT and the other half received low-dose WBCT.  The authors found that use of low-dose WBCT did not increase risk of missed injury diagnosis, while reducing median radiation exposure by almost half.