title: Diagnostic errors in the pediatric and neonatal ICU: a systematic review.
abstract: OBJECTIVE
  Diagnostic errors lead to preventable hospital morbidity and mortality. ICU patients may be at particularly high risk for misdiagnosis. Little is known about misdiagnosis in pediatrics, including PICU and neonatal ICU. We sought to assess diagnostic errors in PICU and neonatal ICU settings by systematic review.
  
  
  METHODS
  We searched PubMed, Embase, CINAHL, and Cochrane.
  
  
  METHODS
  We identified observational studies reporting autopsy-confirmed diagnostic errors in PICU or neonatal ICU using standard Goldman criteria.
  
  
  METHODS
  We abstracted patient characteristics, diagnostic error description, rates and error classes using standard Goldman criteria for autopsy misdiagnoses and calculated descriptive statistics.
  
  
  RESULTS
  We screened 329 citations, examined 79 full-text articles, and included 13 studies (seven PICU; six neonatal ICU). The PICU studies examined a total of 1,063 deaths and 498 autopsies. Neonatal ICU studies examined a total of 2,124 neonatal deaths and 1,259 autopsies. Major diagnostic errors were found in 19.6% of autopsied PICU and neonatal ICU deaths (class I, 4.5%; class II, 15.1%). Class I (potentially lethal) misdiagnoses in the PICU (43% infections, 37% vascular) and neonatal ICU (62% infections, 21% congenital/metabolic) differed slightly. Although missed infections were most common in both settings, missed vascular events were more common in the PICU and missed congenital conditions in the neonatal ICU.
  
  
  CONCLUSIONS
  Diagnostic errors in PICU/neonatal ICU populations are most commonly due to infection. Further research is needed to better quantify pediatric intensive care-related misdiagnosis and to define potential strategies to reduce their frequency or mitigate misdiagnosis-related harm.
authors.affiliation: 1Division of Pediatric Critical Care, Department of Pediatrics, University of Maryland, Baltimore, MD. 2Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 3Welsh Library for the School of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 4Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 5Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Custer
authors.forename: Bradford D
authors.initials: BD
authors.lastname: Winters
authors.forename: Victoria
authors.initials: V
authors.lastname: Goode
authors.forename: Karen A
authors.initials: KA
authors.lastname: Robinson
authors.forename: Ting
authors.initials: T
authors.lastname: Yang
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: David E
authors.initials: DE
authors.lastname: Newman-Toker
mesh_terms: D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D012307:Risk Factors