Carberry Andrea R, Hanson Keith, Flannery Ashley, Fischer Megan, Gehlbach Jonathan, Diamond Carol, Wald Ellen R
1 University of Wisconsin, Madison, WI, USA.
2 University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
Clin Pediatr (Phila). 2018 Jan;57(1):11-18. doi: 10.1177/0009922816687325. Epub 2017 May 8.
The purpose of this study was to ( a) determine the frequency of diagnostic errors in pediatric cancer, ( b) categorize errors, and ( c) underscore themes associated with misdiagnosis. This is a retrospective cohort study at a tertiary children's hospital of 265 patients with new oncologic diagnoses. The diagnostic error rate was 28%. Compared with those with no diagnostic error, those in whom there was an error were more likely to have ( a) more visits before diagnosis ( P < .001), ( b) not been seen in an acute care setting ( P = .03), ( c) inappropriate treatment ( P < .001), and ( d) misinterpreted laboratory studies or imaging ( P < .001). Themes in diagnostic errors were lack of appropriate evaluation for persistent symptoms (47%), failure to recognize signs and symptoms suggestive of malignancy (45%), and misinterpretation of tests (8%). Clinicians should consider diagnostic evaluation for multiple visits for the same complaint or a constellation of signs and symptoms suggestive of malignancy.
(a) 确定儿科癌症诊断错误的发生率；(b) 对错误进行分类；(c) 强调与误诊相关的主题。这是一项在一家三级儿童医院开展的回顾性队列研究，纳入了265例新诊断为肿瘤的患者。诊断错误率为28%。与无诊断错误的患者相比，存在诊断错误的患者更有可能：(a) 在诊断前就诊次数更多（P <.001）；(b) 未在急症环境中就诊（P =.03）；(c) 接受不适当的治疗（P <.001）；(d) 对实验室检查或影像学检查结果解读错误（P <.001）。诊断错误的主题包括对持续症状缺乏适当评估（47%）、未识别出提示恶性肿瘤的体征和症状（45%）以及对检查结果解读错误（8%）。临床医生应考虑对因同一主诉多次就诊或出现提示恶性肿瘤的一系列体征和症状进行诊断评估。
