title: 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.
  
  
  CONCLUSIONS
  Pediatricians reported making diagnostic errors relatively frequently, and patient harm from these errors was not uncommon.
authors.affiliation: Houston Veterans Affairs Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
authors.forename: Lindsey
authors.initials: L
authors.lastname: Wilson
authors.forename: P Adam
authors.initials: PA
authors.lastname: Kelly
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pietz
authors.forename: Dena
authors.initials: D
authors.lastname: Elkeeb
authors.forename: Geeta
authors.initials: G
authors.lastname: Singhal
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D007223:Infant; D016014:Linear Models; D008297:Male; D020380:Needs Assessment; D010372:Pediatrics / Q000706:statistics & numerical data / Q000639:trends; D011159:Population Surveillance; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D011336:Probability; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014481:United States