Department of General Medicine, Kumamoto Medical Center, Kumamoto, Japan.
Department of General Medicine, Koto Toyosu Hospital, Tokyo, Japan.
BMC Emerg Med. 2022 Aug 26;22(1):148. doi: 10.1186/s12873-022-00708-3.
Diagnostic errors constitute an important medical safety problem that needs improvement, and their frequency and severity are high in emergency room settings. Previous studies have suggested that diagnostic errors occur in 0.6-12% of first-time patients in the emergency room and that one or more cognitive factors are involved in 96% of these cases. This study aimed to identify the types of cognitive biases experienced by physicians in emergency rooms in Japan.
We conducted a questionnaire survey using Nikkei Medical Online (Internet) from January 21 to January 31, 2019. Of the 159,519 physicians registered with Nikkei Medical Online when the survey was administered, those who volunteered their most memorable diagnostic error cases in the emergency room participated in the study. EZR was used for the statistical analyses.
A total of 387 physicians were included. The most common cognitive biases were overconfidence (22.5%), confirmation (21.2%), availability (12.4%), and anchoring (11.4%). Of the error cases, the top five most common initial diagnoses were upper gastrointestinal disease (22.7%), trauma (14.7%), cardiovascular disease (10.9%), respiratory disease (7.5%), and primary headache (6.5%). The corresponding final diagnoses for these errors were intestinal obstruction or peritonitis (27.3%), overlooked traumas (47.4%), other cardiovascular diseases (66.7%), cardiovascular disease (41.4%), and stroke (80%), respectively.
A comparison of the initial and final diagnoses of cases with diagnostic errors shows that there were more cases with diagnostic errors caused by overlooking another disease in the same organ or a disease in a closely related organ.
诊断错误是一个重要的医疗安全问题，需要加以改善，在急诊环境中，其频率和严重程度都很高。先前的研究表明，在急诊首次就诊的患者中，有 0.6%至 12%的患者会出现诊断错误，其中 96%的病例涉及一个或多个认知因素。本研究旨在确定日本急诊医生所经历的认知偏差类型。
我们于 2019 年 1 月 21 日至 1 月 31 日通过 Nikkei Medical Online（互联网）进行了问卷调查。在进行调查时，Nikkei Medical Online 注册的 159519 名医生中，有自愿报告急诊室最难忘的诊断错误病例的医生参与了研究。使用 EZR 进行统计分析。
共有 387 名医生入选。最常见的认知偏差包括过度自信（22.5%）、确认偏差（21.2%）、可得性偏差（12.4%）和锚定偏差（11.4%）。在这些错误病例中，初始诊断最常见的前五种疾病是上消化道疾病（22.7%）、创伤（14.7%）、心血管疾病（10.9%）、呼吸道疾病（7.5%）和原发性头痛（6.5%）。这些错误的相应最终诊断分别为肠梗阻或腹膜炎（27.3%）、漏诊创伤（47.4%）、其他心血管疾病（66.7%）、心血管疾病（41.4%）和中风（80%）。
将诊断错误病例的初始和最终诊断进行比较，结果表明，由于忽略同一器官的另一种疾病或密切相关器官的疾病而导致的诊断错误病例更多。
