Harada Yukinori, Kawamura Ren, Yokose Masashi, Shimizu Taro, Singh Hardeep
Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Japan.
Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States.
JMIR Res Protoc. 2024 Mar 25;13:e56933. doi: 10.2196/56933.
Atypical presentations have been increasingly recognized as a significant contributing factor to diagnostic errors in internal medicine. However, research to address associations between atypical presentations and diagnostic errors has not been evaluated due to the lack of widely applicable definitions and criteria for what is considered an atypical presentation.
The aim of the study is to describe how atypical presentations are defined and measured in studies of diagnostic errors in internal medicine and use this new information to develop new criteria to identify atypical presentations at high risk for diagnostic errors.
This study will follow an established framework for conducting scoping reviews. Inclusion criteria are developed according to the participants, concept, and context framework. This review will consider studies that fulfill all of the following criteria: include adult patients (participants); explore the association between atypical presentations and diagnostic errors using any definition, criteria, or measurement to identify atypical presentations and diagnostic errors (concept); and focus on internal medicine (context). Regarding the type of sources, this scoping review will consider quantitative, qualitative, and mixed methods study designs; systematic reviews; and opinion papers for inclusion. Case reports, case series, and conference abstracts will be excluded. The data will be extracted through MEDLINE, Web of Science, CINAHL, Embase, Cochrane Library, and Google Scholar searches. No limits will be applied to language, and papers indexed from database inception to December 31, 2023, will be included. Two independent reviewers (YH and RK) will conduct study selection and data extraction. The data extracted will include specific details about the patient characteristics (eg, age, sex, and disease), the definitions and measuring methods for atypical presentations and diagnostic errors, clinical settings (eg, department and outpatient or inpatient), type of evidence source, and the association between atypical presentations and diagnostic errors relevant to the review question. The extracted data will be presented in tabular format with descriptive statistics, allowing us to identify the key components or types of atypical presentations and develop new criteria to identify atypical presentations for future studies of diagnostic errors. Developing the new criteria will follow guidance for a basic qualitative content analysis with an inductive approach.
As of January 2024, a literature search through multiple databases is ongoing. We will complete this study by December 2024.
This scoping review aims to provide rigorous evidence to develop new criteria to identify atypical presentations at high risk for diagnostic errors in internal medicine. Such criteria could facilitate the development of a comprehensive conceptual model to understand the associations between atypical presentations and diagnostic errors in internal medicine.
Open Science Framework; www.osf.io/27d5m.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56933.
非典型表现日益被认为是内科诊断错误的一个重要促成因素。然而，由于缺乏关于什么是非典型表现的广泛适用的定义和标准，针对非典型表现与诊断错误之间关联的研究尚未得到评估。
本研究的目的是描述在内科诊断错误研究中如何定义和衡量非典型表现，并利用这些新信息制定新的标准，以识别具有诊断错误高风险的非典型表现。
本研究将遵循进行范围综述的既定框架。纳入标准根据参与者、概念和背景框架制定。本综述将考虑符合以下所有标准的研究：纳入成年患者（参与者）；使用任何定义、标准或测量方法来识别非典型表现和诊断错误，探讨非典型表现与诊断错误之间的关联（概念）；并聚焦于内科（背景）。关于资料来源类型，本范围综述将考虑定量、定性和混合方法研究设计；系统综述；以及纳入的观点论文。病例报告、病例系列和会议摘要将被排除。数据将通过检索MEDLINE、科学网、护理学与健康领域数据库、Embase、考克兰图书馆和谷歌学术获取。不设语言限制，将纳入从数据库建立至2023年12月31日索引的论文。两名独立评审员（YH和RK）将进行研究选择和数据提取。提取的数据将包括有关患者特征（如年龄、性别和疾病）的具体细节、非典型表现和诊断错误的定义及测量方法、临床环境（如科室和门诊或住院）、证据来源类型，以及与综述问题相关的非典型表现和诊断错误之间的关联。提取的数据将以表格形式呈现并带有描述性统计，使我们能够识别非典型表现的关键组成部分或类型，并制定新的标准以识别非典型表现，供未来诊断错误研究使用。制定新的标准将遵循基本定性内容分析的指导并采用归纳法。
截至2024年1月，正在通过多个数据库进行文献检索。我们将在2024年12月前完成本研究。
本范围综述旨在提供严谨的证据，以制定新的标准来识别内科中具有诊断错误高风险的非典型表现。这样的标准有助于建立一个全面的概念模型，以理解内科中非典型表现与诊断错误之间的关联。
开放科学框架；www.osf.io/27d5m。
国际注册报告识别号（IRRID）：DERR1-10.2196/56933。
