Division of Pediatric Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA.
Biostatistics Core, Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA.
Pediatr Crit Care Med. 2020 May;21(5):e311-e315. doi: 10.1097/PCC.0000000000002257.
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.
Pilot retrospective cohort study with structured record review using a structured tool (Safer Dx instrument) to identify diagnostic error.
Academic tertiary referral PICU.
Patients 0-17 years old admitted nonelectively to the PICU.
None.
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.
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.
诊断错误可能会对危重症儿童造成伤害。然而，我们对儿科重症监护病房（PICU）中诊断错误的发生率及其相关因素知之甚少。本初步研究的目的是确定通过记录回顾来识别与 PICU 入院后 12 小时内的诊断错误相关的患者、医务人员和工作系统因素的可行性。
采用回顾性队列研究设计，对 50 名患者中的 4 名（8%）进行记录回顾，使用结构化工具（Safer Dx 工具）识别诊断错误。
学术性三级转诊 PICU。
非选择性收治至 PICU 的 0-17 岁患者。
无。
在入院后 12 小时内，有 4 名患者（8%）发生诊断错误。Safer Dx 工具有助于识别慢性耳部感染、颅内压增高（两例）和巴尔通体脑炎的延迟诊断。我们计算出，需要 610 名 PICU 入院患者才能达到 80%的效力（α=0.05），以检测与错误的显著关联。
我们的初步研究发现，50 名非选择性收治至 PICU 的儿童中有 4 名患者发生诊断错误。使用结构化工具通过回顾记录来识别诊断错误在该人群中是可行的。正在使用初步数据来为一项更大规模和更具决定性的多中心研究提供信息。
