Reducing Missed Diagnoses in Pediatric Emergency Cases: A Review Study

Mubarak Saad Aldosary ¹, ‏Amal Khalid Alqablan ¹, ‏Nouf Lafi Alanazi ¹, ‏Manar Humood Alenizi ¹, ‏Abdulelah Mohammed Mubashir Alamri ¹, ‏Fawaz Awdah Mohammad Alshammari ¹, Fayez bin Hindi A Alanazi ¹, Sultan Abdullah Alqahtani ¹, Ahmed Ali Salami ¹, Salem Ibrahim Almishkhas ¹, Omar Mohammed Sulaimani ¹, Shadi Safwat Alkhadra ¹*

Diagnostic errors in pediatric emergency care jeopardize patient safety; this review highlights causes and effective interventions to enhance accuracy.

Abstract

Misdiagnosis in pediatric emergency departments (EDs) poses a major patient safety concern and has been linked to adverse outcomes such as delayed treatment, increased morbidity, and unnecessary costs. This review synthesizes the literature from various peer-reviewed studies to describe the frequency, causes, and interventions to reduce missed diagnoses in pediatric emergency care. Studies report a wide range of rates of diagnostic errors, ranging from 3% (constipation) to 20% (dyspnea without appropriate diagnostic tools). High-risk conditions continue to go misdiagnosed, most notably appendicitis, sepsis, and Kawasaki disease. Diagnostic errors can originate from systemic issues, such as lack of communication, staffing shortages, cognitive issues, such as over-confidence and anchoring bias, as well as patient issues like vague presentation and education, and language barriers. Potential solutions for diagnostic error are technical interventions like natural language processing (NLP) and clinical decision support systems (CDSS). NLP and CDSS types of tools have been shown to decrease missed diagnoses by as much as 15% in some cases. Process-based interventions include standardized clinical processes (e.g., clinical algorithms), and team-based interventions include education-type interventions, e.g., education on cognitive bias, that can all assist in accurate diagnosis, although barriers to implementing the interventions exist. The literature is highly heterogeneous and lacks consistency, e.g., definition or measurement of diagnostic error, thresholds for missed diagnosis, potential cost-benefit analysis of interventions, etc. This review highlights the importance of working towards standardizing definitions of the errors reported, standardized use of effective interventions, nonetheless cost-effectiveness interventions to utilize, and importantly, regular refresher training on cognitive bias in relation to diagnosis with the goal of improving the accuracy and optimizing outcomes for pediatric patients.

Keywords: Diagnostic errors, pediatric emergency, patient safety, clinical decision support, cognitive biases

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