Factors Associated With Diagnostic Error on Admission to a PICU: A Pilot Study

Objectives: Diagnostic errors can harm critically ill children. However, we know little about their prevalence in PICUs and factors associated with error. The objective of this pilot study was to determine feasibility of record review to identify patient, provider, and work system factors associated with diagnostic errors during the first 12 hours after PICU admission. Design: Pilot retrospective cohort study with structured record review using a structured tool (Safer Dx instrument) to identify diagnostic error. Setting: Academic tertiary referral PICU. Patients: Patients 0-17 years old admitted nonelectively to the PICU. Interventions: None. Measurements and Main Results: Four of 50 patients (8%) had diagnostic errors in the first 12 hours after admission. The Safer Dx instrument helped identify delayed diagnoses of chronic ear infection, increased intracranial pressure (two cases), and Bartonella encephalitis. We calculated that 610 PICU admissions are needed to achieve 80% power (α = 0.05) to detect significant associations with error. Conclusions: Our pilot study found four patients with diagnostic error out of 50 children admitted nonelectively to a PICU. Retrospective record review using a structured tool to identify diagnostic errors is feasible in this population. Pilot data are being used to inform a larger and more definitive multicenter study.