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At least 19 recordsLinked to original sources
PubMed1979

The estimation of dental caries incidence in the presence of diagnostic error.

Diagnostic error in large scale screening programs for dental caries is frequent, as when teeth initially classified as carious are later diagnosed as never having been affected by caries. This paper presents a general formulation of diagnostic error in dental caries screening. The basic parameter of the formulation is the caries incidence rate. The general formulation of this paper permits an explicit comparison, in a common notation, of two specific models of diagnostic error--one due to Carlos and Senning, the other to Lu. Each model gives rise to a consistent estimator of the incidence rate. The distributional properties of these estimators had not previously been examined because of the dependence of teeth in the same mouth with respect to caries experience. Using the present formulation, the sampling scheme may be regarded as a one-stage cluster sample with mouths as clusters. This approach accounts for intracluster dependence thus permitting the derivation of an estimator of the relevant covariance matrix and a confidence interval for the incidence rate.

Dental Caries↗
PubMed2005

Diagnostic errors in medicine: a case of neglect.

BACKGROUND: Medical diagnoses that are wrong, missed, or delayed make up a large fraction of all medical errors and cause substantial suffering and injury. Compared with other types of medical error, however, diagnostic errors receive little attention-a major factor in perpetuating unacceptable rates of diagnostic error. Diagnostic errors are fundamentally obscure, health care organizations have not viewed them as a system problem, and physicians responsible for making medical decisions seldom perceive their own error rates as problematic. The safety of modem health care can be improved if these three issues are understood and addressed. SOLUTIONS: Opportunities to improve the visibility of diagnostic errors are evident. Diagnostic error needs to be included in the normal spectrum of quality assurance surveillance and review. The system properties that contribute to diagnostic errors need to be systematically identified and addressed, including issues related to reliable diagnostic testing processes. Even for cases entirely dependent on the skill of the clinician for accurate diagnosis, health care organizations could minimize errors by using system-level interventions to aid the clinician, such as second readings of key diagnostic tests and providing resources for clinical decision support. Physicians need to improve their calibration by getting feedback on the diagnoses they make. Finally, clinicians need to learn about overconfidence and other innate cognitive tendencies that detract from optimal reasoning and learning. CONCLUSION: Clinicians and their health care organizations need to take active steps to discover, analyze, and prevent diagnostic errors.

Diagnostic Errors↗
PubMed2000

[Objective re-evaluation procedures in cases of possible diagnostic error].

Auxiliary diagnostic specialists such as clinical pathologists or radiodiagnosticians may be held liable by injured patients for erroneous diagnoses. Nearly always there will be a reconstruction of the situation in which the alleged misstake was made, and relevant facts will be tested against both professional and legal rules. The Court or one of the parties involved frequently ask an expert for re-evaluation of microscopic preparations, X-rays, etc. This objectivating evaluation requires a procedure that does justice to the original diagnostic situation and therefore should not be made by one single expert familiar with the chain of events. The results of the re-evaluation should be interpreted meticulously and their relative importance established by the Court.

Adult↗
PubMed1998

[Analysis of diagnostic errors and recommendations of diagnostic procedures in bacteriologically negative pulmonary tuberculosis].

The paper presents a detailed analysis of errors in the diagnosis of bacteriologically negative pulmonary tuberculosis in a random sample of 560 patients out of all such patients registered in 1993. The false diagnosis was found in 63 patients i.e. in 11.3% of the sample. Among the 63 patients with false diagnosis of tuberculosis there were 15 cases with lung cancer, 15 cases with pneumonia and/or pleuritis, 15 cases with disease of circulatory system with abnormal radiological of the lungs, 8 cases with old post-tuberculosis changes in the lung considered as relapses, 4 cases of bronchiolitis obliterans with organizing pneumonia, 3 cases of sarcoidosis and 1 case of aspergillosis in a post-tb cavity. The most serious errors were those related to failure in diagnosing (or of too late diagnosis) of lung cancer. These failures comprised 2.7% of patients in the sample. The chance to detect a lung cancer in the sample was 2900 cases in 100,000 men and 2200 cases in 100,000 women. This chance was much higher than in general population--29x for men and 100x for women. The main source of errors was false interpretation of radiological examinations and neglect to utilise other diagnostic procedures like bronchoscopy, cytology or tomography examinations. As an outcome of the analysis authors present their recommendations for diagnostic procedures in the diagnosis of bacteriologically negative pulmonary tuberculosis.

Adult↗
PubMed2002

Diagnostic errors.

One of the most complex and challenging tasks facing physicians is the need to make a diagnosis. Recent research has focused attention on medical errors alleged to have resulted in increased patient morbidity and mortality. A number of authorities have suggested methods to track and prevent errors. Most have dealt with systems' changes and fail-safe methods to prevent medication errors and commission of errors during treatment. Few have addressed methods to find and prevent diagnostic errors. Unless diagnostic error is either avoided or corrected early, fail-safe methods to prevent medication and treatment errors will ultimately fail to improve patient outcome. American medical literature, particularly postmortem studies, have documented diagnostic error since at least 1912. European literature shows the problem is worldwide. The limits of human memory and errors in both observation and processing of information during problem solving contribute to the commission of errors. The purpose of this article is to examine the thinking patterns and cognitive errors that can result in diagnostic error, and suggest instructional strategies that can be used to alert residents and attending physicians to these potential problems so they can be avoided.

Diagnostic Errors↗
PubMed2005

Iatrogenic harm caused by diagnostic errors in fibrodysplasia ossificans progressiva.

BACKGROUND: Little is known about diagnostic errors for a disease worldwide. Such errors could alter the disease's natural history, especially if unwarranted interventions cause irreversible harm. Fibrodysplasia ossificans progressiva (FOP), a rare, autosomal dominant genetic disease characterized by episodes of permanent heterotopic ossification of soft tissues, occurs worldwide without racial, ethnic, or geographic predilection. There is no effective treatment, and soft-tissue trauma (eg, biopsies, surgical procedures, intramuscular injections, or mandibular blocks for dental procedures) and viral illnesses are likely to induce episodes of rapidly progressive heterotopic ossification, with resultant permanent loss of motion in the affected area. Accurate diagnoses can be made on the basis of the clinical findings of tumor-like swellings on the head, neck, back, or shoulders and characteristic short great toes with hallux valgus-like malformations and missing interphalangeal joints. On the basis of conversations with numerous individuals with FOP, we suspected that diagnostic errors with FOP are common and often associated with inappropriate and harmful diagnostic and therapeutic procedures. OBJECTIVE: To document the frequency of diagnostic errors with FOP and complications resulting from misdiagnoses. DESIGN: A questionnaire requesting detailed demographic, diagnostic, and treatment information was sent to all 269 patient-members of the International FOP Association; the sampling frame included > 90% of all known FOP patients worldwide. We received 138 replies (51% response) from 25 countries. The age range was 2 to 71 years; there were 78 female subjects and 60 male subjects. In addition, to assess the availability and adequacy of information about FOP, we reviewed 184 English-language textbooks in relevant specialties published in the past 20 years. RESULTS: Incorrect diagnoses were given initially to 87% of individuals with FOP. This astonishing rate of diagnostic errors occurred worldwide, regardless of ethnicity, geographic background, or misdiagnosing physician's specialty. The most common incorrect diagnosis was cancer (32%). The mean period from the onset of symptoms to correct diagnosis was 4.1 years, and the median number of physicians consulted before the correct diagnosis of FOP was 6. For 67% of patients, unnecessary invasive procedures (biopsies) were performed; 68% received inappropriate therapies. Forty-nine percent of all patients reported permanent loss of mobility resulting from invasive medical interventions that caused posttraumatic ossification. Notably, only 8% of the 184 textbooks that were reviewed contained adequate descriptions of FOP, including the caution that trauma can accelerate the process of heterotopic ossification. CONCLUSIONS: Diagnostic errors and inappropriate medical procedures, which may lead to permanent harm, can alter the natural history of a disease. In FOP, the astonishing rates of diagnostic errors and inappropriate invasive medical procedures likely result from lack of physician awareness because of failure of information transfer.

Adolescent↗
PubMed1984

[Electrocardiographic inferences as a cause of diagnostic errors].

The authors analyzed the cause of diagnostic errors due to incorrect ECG interpretation. It was revealed that the cause for diagnostic errors may lie in the inadequate experience of the electrocardiologist , the overestimation of the method potentialities and the absence of the commonly accepted language of ECG interpretation. The necessity is emphasized of the clear cut differentiation between the electrophysiological and clinical-morphological approaches to the formation of the language of ECG interpretation. The clinical-morphological approach in clinical practice is acceptable only provided that the electrocardiologist is acquainted with the clinical picture of the disease. The use of this approach disregarding the clinical findings constitutes one of the causes of diagnostic errors and iatrogenia .

Cardiology↗
PubMed2001

Diagnostic errors in an accident and emergency department.

OBJECTIVES: To describe the diagnostic errors occurring in a busy district general hospital accident and emergency (A&E) department over four years. METHOD: All diagnostic errors discovered by or notified to one A&E consultant were noted on a computerised database. RESULTS: 953 diagnostic errors were noted in 934 patients. Altogether 79.7% were missed fractures. The most common reasons for error were misreading radiographs (77.8%) and failure to perform radiography (13.4%). The majority of errors were made by SHOs. Twenty two diagnostic errors resulted in complaints and legal actions and three patients who had a diagnostic error made, later died. CONCLUSIONS: Good clinical skills are essential. Most abnormalities missed on radiograph were not difficult to diagnose. Junior doctors in A&E should receive specific training and be tested on their ability to interpret radiographs correctly before being allowed to work unsupervised.

Diagnostic Errors↗
PubMed2002

Patterns of diagnostic error in trauma abdominal CT.

OBJECTIVE: To define patterns of diagnostic error in the interpretation of trauma abdominal CT. MATERIALS AND METHODS: Two hundred fifty-four out of 1751 abdominal CT scans performed for evaluation of trauma had a definite or equivocal diagnosis of an abdominal injury. Cases were re-read initially without reference to the original reports, in which 44 potential diagnostic errors were identified. A panel of two or three expert readers reviewed each of the 44 cases along with the original report to evaluate the diagnostic error and to search for patterns among the errors. RESULTS: Thirty-one of the 254 CT scans (12%) that were re-read contained non-trivial mistakes that could affect patient outcome. Seventeen were false negative and 14 were false positive. Diagnostic errors were found in the liver, spleen, kidney, retroperitoneum, and peritoneal cavity. Patterns of false-negative diagnosis included missed vascular contrast extravasation, missed hemoperitoneum, and missed right retroperitoneal hematoma. Patterns of false-positive diagnosis included: periportal edema or blood tracking, called a liver laceration; respiratory motion, called a splenic or renal injury; and linear or round lucencies in the spleen or liver, called a laceration. CONCLUSION: Diagnostic errors in interpreting trauma abdominal CT cluster in several recurring patterns. Awareness of these patterns may assist readers in avoiding future errors.

Journal Article↗