Otani Yuki, Aizawa Yuta, Hataya Hiroshi, Horikoshi Yuho
Division of General Pediatrics, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan.
Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan.
Pediatr Int. 2019 Oct;61(10):988-993. doi: 10.1111/ped.13979.
Clinical evidence for improving diagnostic accuracy in pediatric medicine is still scarce. Septic osteomyelitis is sometimes challenging for physicians to diagnose. The aim of this study was to improve patient care through identifying the incidence and reasons for errors in the diagnosis of bacterial osteomyelitis in pediatric patients.
We retrospectively identified patients younger than 16 years with acute or chronic osteomyelitis at Tokyo Metropolitan Children's Medical Center between April 2010 and September 2017. We extracted data on patient demographics, clinical course, symptoms, locus of the lesions, and diagnosis at presentation and discharge. The patients were categorized into the misdiagnosis and non-misdiagnosis groups following a review by two pediatricians. Misdiagnosis was defined as a difference between the initial and discharge diagnosis. The factors in the two groups were compared, and the types of error in the misdiagnosis group were examined.
In total 71 patients were enrolled. The median age and proportion of boys was 7.6 years (IQR, 1.4-11.2 years) and 66%, respectively. Misdiagnosis occurred in 27 patients (38.0%). Precedent antibiotic use was independently associated with misdiagnosis (P = 0.044). A cognitive error was observed in 88.3% of the misdiagnosis group. The median number of types of error per case was 2.0 (IQR, 2.0-3.0).
The misdiagnosis of septic osteomyelitis in pediatric patients was common and chiefly caused by cognitive errors. Eliminating cognitive errors in diagnosis is highly likely to improve the care of patients with osteomyelitis.
提高儿科学诊断准确性的临床证据仍然匮乏。脓毒性骨髓炎有时对医生的诊断具有挑战性。本研究的目的是通过确定儿科患者细菌性骨髓炎诊断错误的发生率和原因来改善患者护理。
我们回顾性确定了2010年4月至2017年9月期间在东京都儿童医疗中心年龄小于16岁的急性或慢性骨髓炎患者。我们提取了患者的人口统计学数据、临床病程、症状、病变部位以及就诊时和出院时的诊断信息。经两位儿科医生复查后，将患者分为误诊组和非误诊组。误诊定义为初始诊断与出院诊断之间的差异。比较两组的因素，并检查误诊组的错误类型。
共纳入71例患者。中位年龄为7.6岁（四分位间距，1.4 - 11.2岁），男孩比例为66%。27例患者（38.0%）发生误诊。先前使用抗生素与误诊独立相关（P = 0.044）。在88.3%的误诊组中观察到认知错误。每例错误类型的中位数为2.0（四分位间距，2.0 - 3.0）。
儿科患者脓毒性骨髓炎的误诊很常见，主要由认知错误引起。消除诊断中的认知错误极有可能改善骨髓炎患者的护理。
