Errors of diagnosis in pediatric practice: a multisite survey

Abstract

Objective: We surveyed pediatricians to elicit their perceptions regarding frequency, contributing factors, and potential system- and provider-based solutions to address diagnostic errors.

Methods: Academic, community, and trainee pediatricians (N = 1362) at 3 tertiary care institutions and 109 affiliated clinics were invited to complete the survey anonymously through an Internet survey administration service between November 2008 and May 2009.

Results: The overall response rate was 53% (N = 726). More than one-half (54%) of respondents reported that they made a diagnostic error at least once or twice per month; this frequency was markedly higher (77%) among trainees. Almost one-half (45%) of respondents reported diagnostic errors that harmed patients at least once or twice per year. Failure to gather information through history, physical examination, or chart review was the most-commonly reported process breakdown, whereas inadequate care coordination and teamwork was the most-commonly reported system factor. Viral illnesses being diagnosed as bacterial illnesses was the most-commonly reported diagnostic error, followed by misdiagnosis of medication side effects, psychiatric disorders, and appendicitis. Physicians ranked access to electronic health records and close follow-up of patients as strategies most likely to be effective in preventing diagnostic errors.

Conclusion: Pediatricians reported making diagnostic errors relatively frequently, and patient harm from these errors was not uncommon.

Figure 1

Figures 1A and 1B: Frequency of Diagnostic Errors Regardless of Patient Harm (1A) and Frequency of Diagnostic Errors that Caused Patient Harm (1B) Self-reported by Pediatricians Note: Percentages reported in the text are higher because they reflect cumulative frequencies.