Michelson Kenneth A, Grubenhoff Joseph A
Division of Emergency Medicine, Ann & Robert Lurie Children's Hospital, Chicago, IL.
Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO.
Ann Emerg Med. 2025 Sep 3. doi: 10.1016/j.annemergmed.2025.07.035.
To evaluate the proportion of emergency departments (EDs) with sufficient volumes to measure pediatric misdiagnosis reliably.
We conducted a cross-sectional study of a nationally representative 20% sample of US EDs within the 2022 Nationwide Emergency Department Sample. We counted the number of child visits (less than 18 years old) at each ED for each of 24 serious pediatric emergency conditions and each ED's total across all conditions. We calculated the proportion of EDs that could reliably measure misdiagnosis rates at least 10% worse than condition-specific national reference standards. We also calculated the proportion of children visiting measurable EDs.
Reliable misdiagnosis measurement across all serious conditions was possible in 614 out of 4,515 EDs (13.6%, 95% confidence interval [CI] 11.5 to 15.9). Appendicitis was the most reliably measurable condition (n=530 EDs, 11.7%, 95% CI 9.8 to 14.0), whereas complicated pneumonia (n=33, 0.7%, 95% CI 0.3 to 1.5), testicular torsion (n=29, 0.6%, 95% CI 0.2-1.4), and intussusception (n=25, 0.6%, 95% CI 0.2 to 1.2) were less frequently measurable. The 20 other included conditions were not reliably measurable in any ED (0.0%, 95% CI 0.0 to 0.4). Midwest, nonmetropolitan, and EDs evaluating less than 1,800 children per year were least likely to be able to support reliable measurement. Among 185,490 children with a serious condition, 130,894 (70.6%) visited an ED in which misdiagnosis was measurable.
Few EDs have sufficient pediatric volumes to reliably measure diagnostic accuracy generally, and even fewer can do so for individual conditions. Aggregation of EDs could improve power to measure misdiagnosis.
评估拥有足够就诊量以可靠测量儿科误诊情况的急诊科比例。
我们对2022年全国急诊科样本中具有全国代表性的20%的美国急诊科进行了横断面研究。我们统计了每家急诊科针对24种严重儿科急诊病症中每种病症的儿童就诊次数（小于18岁）以及每家急诊科所有病症的就诊总数。我们计算了误诊率至少比特定病症的全国参考标准差10%时能够可靠测量误诊率的急诊科比例。我们还计算了前往可测量误诊率的急诊科就诊的儿童比例。
在4515家急诊科中，有614家（13.6%，95%置信区间[CI]为11.5%至15.9%）能够对所有严重病症进行可靠的误诊测量。阑尾炎是最易于可靠测量的病症（530家急诊科，11.7%，95%CI为9.8%至14.0%），而复杂性肺炎（33家，0.7%，95%CI为0.3%至1.5%）、睾丸扭转（29家，0.6%，95%CI为0.2%至1.4%）和肠套叠（25家，0.6%，95%CI为0.2%至1.2%）的测量频率较低。其他20种病症在任何急诊科都无法进行可靠测量（0.0%，95%CI为0.0%至0.4%）。中西部地区、非大都市地区以及每年评估儿童少于1800例的急诊科最不可能支持可靠测量。在185490例患有严重病症的儿童中，有130894例（70.6%）前往了能够测量误诊率的急诊科就诊。
一般而言，很少有急诊科拥有足够的儿科就诊量来可靠地测量诊断准确性，对于个别病症能够做到的急诊科更少。汇总急诊科的数据可能会提高测量误诊率的效能。
