Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
VA Connecticut Health System West Haven Campus, West Haven, Connecticut, USA.
BMJ Qual Saf. 2020 Dec;29(12):1008-1018. doi: 10.1136/bmjqs-2019-010822. Epub 2020 Apr 8.
Diagnostic error is commonly defined as a missed, delayed or wrong diagnosis and has been described as among the most important patient safety hazards. Diagnostic errors also account for the largest category of medical malpractice high severity claims and total payouts. Despite a large literature on the incidence of inpatient adverse events, no systematic review has attempted to estimate the prevalence and nature of harmful diagnostic errors in hospitalised patients.
A systematic literature search was conducted using Medline, Embase, Web of Science and the Cochrane library from database inception through 9 July 2019. We included all studies of hospitalised adult patients that used physician review of case series of admissions and reported the frequency of diagnostic adverse events. Two reviewers independently screened studies for inclusion, extracted study characteristics and assessed risk of bias. Harmful diagnostic error rates were pooled using random-effects meta-analysis.
Twenty-two studies including 80 026 patients and 760 harmful diagnostic errors from consecutive or randomly selected cohorts were pooled. The pooled rate was 0.7% (95% CI 0.5% to 1.1%). Of the 136 diagnostic errors that were described in detail, a wide range of diseases were missed, the most common being malignancy (n=15, 11%) and pulmonary embolism (n=13, 9.6%). In the USA, these estimates correspond to approximately 249 900 harmful diagnostic errors yearly.
Based on physician review, at least 0.7% of adult admissions involve a harmful diagnostic error. A wide range of diseases are missed, including many common diseases. Fourteen diagnoses account for more than half of all diagnostic errors. The finding that a wide range of common diagnoses are missed implies that efforts to improve diagnosis must target the basic processes of diagnosis, including both cognitive and system-related factors.
CRD42018115186.
诊断错误通常被定义为漏诊、延迟诊断或误诊，已被描述为最重要的患者安全隐患之一。诊断错误也是医疗事故中导致最高赔偿金额的最大类别。尽管有大量关于住院患者不良事件发生率的文献，但尚无系统评价试图估计住院患者中有害诊断错误的流行率和性质。
我们使用 Medline、Embase、Web of Science 和 Cochrane 图书馆，从数据库建立到 2019 年 7 月 9 日，进行了系统文献检索。我们纳入了所有使用医师审查住院患者病例系列并报告诊断不良事件频率的研究。两名评审员独立筛选纳入研究，提取研究特征并评估偏倚风险。使用随机效应荟萃分析汇总有害诊断错误率。
纳入了 22 项研究，共纳入 80026 例患者和 760 例有害诊断错误，这些研究来自连续或随机选择的队列。汇总率为 0.7%（95%CI 0.5%~1.1%）。在详细描述的 136 个诊断错误中，范围广泛的疾病被漏诊，最常见的是恶性肿瘤（n=15，11%）和肺栓塞（n=13，9.6%）。在美国，这些估计值相当于每年约有 249900 例有害诊断错误。
基于医师审查，至少 0.7%的成年患者入院时发生有害诊断错误。漏诊的疾病范围广泛，包括许多常见疾病。14 种诊断占所有诊断错误的一半以上。发现广泛的常见诊断被漏诊意味着，提高诊断质量的努力必须针对诊断的基本过程，包括认知和系统相关因素。
PROSPERO 注册号：CRD42018115186。
