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2017 ; 25
(1
): 13
Nephropedia Template TP
gab.com Text
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English Wikipedia
Diagnostic error in the Emergency Department: follow up of patients with minor
trauma in the outpatient clinic
#MMPMID28196544
Moonen PJ
; Mercelina L
; Boer W
; Fret T
Scand J Trauma Resusc Emerg Med
2017[Feb]; 25
(1
): 13
PMID28196544
show ga
BACKGROUND: The Emergency Department (ED) is prone to diagnostic error. Most
frequent diagnostic errors involved "minor" trauma. Our goal was to determine how
frequently a missed diagnosis was detected during follow up and to determine the
frequency and causes of primary missed diagnosis and diagnostic error. METHODS: A
retrospective single centre study review, during 6 months including all patients
presenting to the outpatient clinic after ED admission with a minor trauma. We
defined primary missed diagnosis versus diagnostic error. Demographic data were
collected in Excel file and analyzed using ?(2) and unpaired T-test. RESULTS:
Inclusion of 56 patients leading to 57 missed diagnoses representing 1.39% of all
minor trauma patients presenting to the ED. History and physical examination
notes were incomplete or inadequate in respectively 17/56 and 20/56. Most
frequently missed diagnoses were ankle (13/57), wrist (8/57) and foot (7/57)
fractures. Causes for diagnostic error could be categorized into two main groups:
failure to perform adequate history taking and/or physical examination and
failure to order or correctly interpret technical investigation. In 6 cases
(0.14%) diagnostic error was confirmed. All other cases were defined as primary
missed diagnosis. DISCUSSION: Emergency physicians have to remain vigilant to
prevent and avoid primary missed diagnosis (PMD) and diagnostic error (DE),
certainly in case of minor trauma patients, representing a large proportion of ED
patients. We observed a prevalence of 1.39% of missed diagnoses within a six
month study period. This is comparable to previous studies (1% ). However in our
study both primary missed diagnoses and DE were included. Using this definition
we saw that only one case could be attributed to negligence and DE had a
prevalence of 0.14% (6 cases). X-rays remain the mainstay investigation for minor
trauma patients, however in certain selected cases (pelvic and spinal trauma) we
advise early CT-scan.Follow up in an outpatient clinic or other forms of planned
follow up have to be provided and help to reduce PMD and DE. CONCLUSION: Both
primary missed diagnosis and diagnostic error have relatively low prevalence but
have a serious impact on patients, hospitals and medical services. Planned follow
up after adequate explanation can help to prevent diagnostic error and detect
primary missed diagnosis, thereby reducing time to final diagnosis and risks for
medico legal litigation. Reassessment of diagnostic error on a timely basis can
be used as a key performance indicator in a quality assessment program.
|*Ambulatory Care Facilities
[MESH]
|*Continuity of Patient Care
[MESH]
|*Emergency Service, Hospital
[MESH]
|Belgium
[MESH]
|Diagnostic Errors/*statistics & numerical data
[MESH]