title: Diagnostic error in children presenting with acute medical illness to a community hospital.
abstract: OBJECTIVE
  To determine incidence and aetiology of diagnostic errors in children presenting with acute medical illness to a community hospital.
  
  
  METHODS
  A three-stage study was conducted. Stage 1: retrospective case note review, comparing admission to discharge diagnoses of children admitted to hospital, to determine incidence of diagnostic error. Stage 2: cases of suspected misdiagnosis were examined in detail by two reviewers. Stage 3: structured interviews were conducted with clinicians involved in these cases to identify contributory factors.
  
  
  METHODS
  UK community (District General) hospital.
  
  
  METHODS
  All medical patients admitted to the paediatric ward and patients transferred from the Emergency Department to a different facility over a 90-day period were included.
  
  
  METHODS
  Incidence of diagnostic error, type of diagnostic error and content analysis of the structured interviews to determine frequency of emerging themes.
  
  
  RESULTS
  Incidence of misdiagnosis in children presenting with acute illness was 5.0% (19/378, 95% confidence interval (CI) 2.8-7.2%). Diagnostic errors were multi-factorial in origin, commonly involving cognitive factors. Reviewers 1 and 2 identified a median of three and four errors per case, respectively. In 14 cases, structured interviews were possible; clinicians believed system-related errors (organizational flaws, e.g. inadequate policies, staffing or equipment) contributed more commonly to misdiagnoses, whereas reviewers found cognitive factors contributed more commonly to diagnostic error.
  
  
  CONCLUSIONS
  Misdiagnoses occurred in 5% of children presenting with acute illness and were multi-factorial in aetiology. Multi-site longitudinal studies further exploring aetiology of errors and effect of educational interventions are required to generalize these findings and determine strategies for mitigation.
authors.affiliation: Department of Paediatrics, North West London Hospitals NHS Trust, London HA1 3UJ, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Warrick
authors.affiliation: Department of Paediatrics, North West London Hospitals NHS Trust, London HA1 3UJ, UK.
authors.forename: Poonam
authors.initials: P
authors.lastname: Patel
authors.affiliation: Department of Paediatrics, North West London Hospitals NHS Trust, London HA1 3UJ, UK.
authors.forename: Warren
authors.initials: W
authors.lastname: Hyer
authors.affiliation: Centre for Patient Safety and Service Quality, Imperial College London, London W2 1NY, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Neale
authors.affiliation: Centre for Patient Safety and Service Quality, Imperial College London, London W2 1NY, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
authors.affiliation: Department of Paediatrics, Imperial College London, London W2 1NY, UK.
authors.forename: David
authors.initials: D
authors.lastname: Inwald
mesh_terms: D003071:Cognition; D003951:Diagnostic Errors / Q000145:classification* / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D010348:Patient Care Team; D012189:Retrospective Studies; D013997:Time Factors; D006113:United Kingdom
keywords: cognitive bias; diagnostic error; paediatrics