Frequency of Different Types of Diagnostic Errors in Patients with Central Nervous System Infections: A Cross-Sectional Observational Study

OBJECTIVES: To assess the frequency of different types of diagnostic errors in patients with central nervous system (CNS) infection from the onset of symptoms to admission to the hospital, where the correct diagnosis was made. METHODS: A cross-sectional observational design was used, and the informa...

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Autores principales: Naderi, HamidReza, Sheybani, Fereshte, Khosravi, Omid, Jabbari Nooghabi, Mehdi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276390/
https://www.ncbi.nlm.nih.gov/pubmed/30581622
http://dx.doi.org/10.1155/2018/4210737
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author Naderi, HamidReza
Sheybani, Fereshte
Khosravi, Omid
Jabbari Nooghabi, Mehdi
author_facet Naderi, HamidReza
Sheybani, Fereshte
Khosravi, Omid
Jabbari Nooghabi, Mehdi
author_sort Naderi, HamidReza
collection PubMed
description OBJECTIVES: To assess the frequency of different types of diagnostic errors in patients with central nervous system (CNS) infection from the onset of symptoms to admission to the hospital, where the correct diagnosis was made. METHODS: A cross-sectional observational design was used, and the information was collected by interviewing patients and/or their knowledgeable relatives as well as reviewing the accompanying medical record documents and hospital records. RESULTS: Of 169 adult patients with CNS infection, 129 (76.33%) were subject to diagnostic errors. Failure in ordering tests and hypothesis generation were the most common types of diagnostic errors that accounted for more than 70% of errors. Several contributing factors that were associated with incorrect diagnostic hypotheses included failure in taking a patient's comprehensive history such as detecting relevant epidemiological clues, conducting a full clinical examination, and interpreting diagnostic evidence. The relationship between poor clinical outcome and longer delay from the onset of illness to diagnosis, inappropriate empirical antibiotic therapy, and lower level of consciousness on admission were found to be statistically significant. CONCLUSIONS: Although diagnosis and management of CNS infection in some patients are straightforward, clinical decision making in facing patients with complex scenarios often requires clinical reasoning instead of relying only on intuitive diagnosis. Justification in requesting diagnostic measures and interpretation of their results based on clinical findings and patient information could be a critical factor in preventing a substantial number of diagnostic errors in patients with CNS infection.
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spelling pubmed-62763902018-12-23 Frequency of Different Types of Diagnostic Errors in Patients with Central Nervous System Infections: A Cross-Sectional Observational Study Naderi, HamidReza Sheybani, Fereshte Khosravi, Omid Jabbari Nooghabi, Mehdi Neurol Res Int Research Article OBJECTIVES: To assess the frequency of different types of diagnostic errors in patients with central nervous system (CNS) infection from the onset of symptoms to admission to the hospital, where the correct diagnosis was made. METHODS: A cross-sectional observational design was used, and the information was collected by interviewing patients and/or their knowledgeable relatives as well as reviewing the accompanying medical record documents and hospital records. RESULTS: Of 169 adult patients with CNS infection, 129 (76.33%) were subject to diagnostic errors. Failure in ordering tests and hypothesis generation were the most common types of diagnostic errors that accounted for more than 70% of errors. Several contributing factors that were associated with incorrect diagnostic hypotheses included failure in taking a patient's comprehensive history such as detecting relevant epidemiological clues, conducting a full clinical examination, and interpreting diagnostic evidence. The relationship between poor clinical outcome and longer delay from the onset of illness to diagnosis, inappropriate empirical antibiotic therapy, and lower level of consciousness on admission were found to be statistically significant. CONCLUSIONS: Although diagnosis and management of CNS infection in some patients are straightforward, clinical decision making in facing patients with complex scenarios often requires clinical reasoning instead of relying only on intuitive diagnosis. Justification in requesting diagnostic measures and interpretation of their results based on clinical findings and patient information could be a critical factor in preventing a substantial number of diagnostic errors in patients with CNS infection. Hindawi 2018-11-19 /pmc/articles/PMC6276390/ /pubmed/30581622 http://dx.doi.org/10.1155/2018/4210737 Text en Copyright © 2018 HamidReza Naderi et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Naderi, HamidReza
Sheybani, Fereshte
Khosravi, Omid
Jabbari Nooghabi, Mehdi
Frequency of Different Types of Diagnostic Errors in Patients with Central Nervous System Infections: A Cross-Sectional Observational Study
title Frequency of Different Types of Diagnostic Errors in Patients with Central Nervous System Infections: A Cross-Sectional Observational Study
title_full Frequency of Different Types of Diagnostic Errors in Patients with Central Nervous System Infections: A Cross-Sectional Observational Study
title_fullStr Frequency of Different Types of Diagnostic Errors in Patients with Central Nervous System Infections: A Cross-Sectional Observational Study
title_full_unstemmed Frequency of Different Types of Diagnostic Errors in Patients with Central Nervous System Infections: A Cross-Sectional Observational Study
title_short Frequency of Different Types of Diagnostic Errors in Patients with Central Nervous System Infections: A Cross-Sectional Observational Study
title_sort frequency of different types of diagnostic errors in patients with central nervous system infections: a cross-sectional observational study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276390/
https://www.ncbi.nlm.nih.gov/pubmed/30581622
http://dx.doi.org/10.1155/2018/4210737
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