Study Finds High Rates of Errors, Missed Diagnoses in Pediatric Patients

Diagnostic errors and missed diagnoses are common in pediatric practices, according to an AHRQ-funded study. Researchers analyzed data from 25 pediatric practices during a 5-month period in 2015. They found diagnostic error rates of 54 percent for pediatric patients with elevated blood pressure and 11 percent for patients with abnormal laboratory values. The rate of missed opportunities to evaluate adolescents for depression was 62 percent. The results were among the first to provide national estimates on the frequency of pediatric diagnostic errors and missed opportunities for diagnosis. Study authors concluded that practitioners should work to measure and reduce these high-frequency errors to avoid care delays and patient harm. Access the abstract of the study, which was published in Academic Pediatrics.

2017 Aug 10. pii: S1876-2859(17)30463-1. doi: 10.1016/j.acap.2017.08.005. [Epub ahead of print]

Diagnostic Errors in Primary Care Pediatrics: Project RedDE.

Rinke ML1, Singh H2, Heo M3, Adelman JS4, O'Donnell HC5, Choi SJ5, Norton A6, Stein REK5, Brady TM7, Lehmann CU8, Kairys SW9, Rice-Conboy E10, Thiessen K10, Bundy DG11.

Author information

Abstract

OBJECTIVE:

Diagnostic errors (DEs), which encompass failures of accuracy, timeliness, or patient communication, cause appreciable morbidity but are understudied in pediatrics. Pediatricians have expressed interest in reducing high-frequency/subacute DEs, but their epidemiology remains unknown. The objective of this study was to investigate the frequency of two high-frequency/subacute DEs and one missed opportunity for diagnosis (MOD) in primary care pediatrics.

METHODS:

As part of a national quality improvement collaborative, 25 primary care pediatric practices were randomized to collect 5 months of retrospective data on one DE or MOD: elevated blood pressure (BP) and abnormal laboratory values (DEs), or adolescent depression evaluation (MOD). Relationships between DE or MOD proportions and patient age, gender, and insurance status were explored with mixed-effects logistic regression models.

RESULTS:

DE or MOD rates in pediatric primary care were found to be 54% for patients with elevated BP (n = 389), 11% for patients with abnormal laboratory values (n = 381), and 62% for adolescents with an opportunity to evaluate for depression (n = 400). When examining the number of times a pediatrician may have recognized an abnormal condition but either knowingly or unknowingly did not act according to recommended guidelines, providers did not document recognition of an elevated BP in 51% of patients with elevated BP, and they did not document recognition of an abnormal laboratory value without a delay in 9% of patients with abnormal laboratory values.