Christina L Cifra1, Patrick Ten Eyck2, Jeffrey D Dawson3, Heather Schacht Reisinger4,5, Hardeep Singh6, Loreen A Herwaldt4. 1. Division of Pediatric Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA. 2. Biostatistics Core, Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA. 3. Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA. 4. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA. 5. Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA. 6. Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX.
Abstract
OBJECTIVES: Diagnostic errors can harm critically ill children. However, we know little about their prevalence in PICUs and factors associated with error. The objective of this pilot study was to determine feasibility of record review to identify patient, provider, and work system factors associated with diagnostic errors during the first 12 hours after PICU admission. DESIGN: Pilot retrospective cohort study with structured record review using a structured tool (Safer Dx instrument) to identify diagnostic error. SETTING: Academic tertiary referral PICU. PATIENTS: Patients 0-17 years old admitted nonelectively to the PICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Four of 50 patients (8%) had diagnostic errors in the first 12 hours after admission. The Safer Dx instrument helped identify delayed diagnoses of chronic ear infection, increased intracranial pressure (two cases), and Bartonella encephalitis. We calculated that 610 PICU admissions are needed to achieve 80% power (α = 0.05) to detect significant associations with error. CONCLUSIONS: Our pilot study found four patients with diagnostic error out of 50 children admitted nonelectively to a PICU. Retrospective record review using a structured tool to identify diagnostic errors is feasible in this population. Pilot data are being used to inform a larger and more definitive multicenter study.
OBJECTIVES: Diagnostic errors can harm critically illchildren. However, we know little about their prevalence in PICUs and factors associated with error. The objective of this pilot study was to determine feasibility of record review to identify patient, provider, and work system factors associated with diagnostic errors during the first 12 hours after PICU admission. DESIGN: Pilot retrospective cohort study with structured record review using a structured tool (Safer Dx instrument) to identify diagnostic error. SETTING: Academic tertiary referral PICU. PATIENTS: Patients 0-17 years old admitted nonelectively to the PICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Four of 50 patients (8%) had diagnostic errors in the first 12 hours after admission. The Safer Dx instrument helped identify delayed diagnoses of chronic ear infection, increased intracranial pressure (two cases), and Bartonella encephalitis. We calculated that 610 PICU admissions are needed to achieve 80% power (α = 0.05) to detect significant associations with error. CONCLUSIONS: Our pilot study found four patients with diagnostic error out of 50 children admitted nonelectively to a PICU. Retrospective record review using a structured tool to identify diagnostic errors is feasible in this population. Pilot data are being used to inform a larger and more definitive multicenter study.
Authors: Christina L Cifra; Kareen L Jones; Judith A Ascenzi; Utpal S Bhalala; Melania M Bembea; David E Newman-Toker; James C Fackler; Marlene R Miller Journal: Pediatr Crit Care Med Date: 2015-06 Impact factor: 3.624
Authors: A Abella; C Hermosa; V Enciso; I Torrejón; R Molina; M Díaz; T Mozo; F Gordo; I Salinas Journal: Med Intensiva Date: 2015-02-11 Impact factor: 2.491
Authors: Maria Caridad Davalos; Kenya Samuels; Ashley N D Meyer; Satid Thammasitboon; Moushumi Sur; Kevin Roy; Aymer Al-Mutairi; Hardeep Singh Journal: Pediatr Crit Care Med Date: 2017-03 Impact factor: 3.624
Authors: Aymer Al-Mutairi; Ashley N D Meyer; Eric J Thomas; Jason M Etchegaray; Kevin M Roy; Maria Caridad Davalos; Shazia Sheikh; Hardeep Singh Journal: J Gen Intern Med Date: 2016-02-22 Impact factor: 5.128
Authors: Daniel R Murphy; Ashley Nd Meyer; Dean F Sittig; Derek W Meeks; Eric J Thomas; Hardeep Singh Journal: BMJ Qual Saf Date: 2018-10-05 Impact factor: 7.035
Authors: Kenneth A Michelson; David N Williams; Arianna H Dart; Prashant Mahajan; Emily L Aaronson; Richard G Bachur; Jonathan A Finkelstein Journal: Diagnosis (Berl) Date: 2020-06-26
Authors: Christina L Cifra; Kimberly C Dukes; Brennan S Ayres; Kelsey A Calomino; Loreen A Herwaldt; Hardeep Singh; Heather Schacht Reisinger Journal: J Crit Care Date: 2020-09-18 Impact factor: 4.298