A recent study underscores the danger to pediatric patients from a missed diagnosis.
Accurate and timely diagnosis is a priority in any area of healthcare. For the youngest patients, a missed or inaccurate diagnosis can lead to worsening symptoms, needless complications, lengthened treatment or hospitalization—and the possibility of an outcome of disability or death. While that is a lot riding on the judgment of an Emergency Department (ED) provider, it is not unwarranted and it is the expectation of EDs role in healthcare.
A recent study published in The Journal of Emergency Medicine looked at ED patient data to evaluate five pediatric EDs to learn how missed diagnosis impacts complication rates on conditions including sepsis, pediatric appendicitis, and new-onset diabetic ketoacidosis (DKA).
Study authors note pediatric patients can suffer an increased risk of misdiagnosis for a couple of reasons. The quality and complexity of health services offered to pediatric patients varies, and is oftentimes lacking. In addition to incorrect diagnosis, medication errors can occur more easily because pharmaceuticals are not formulated for the physiologic needs of children—but rather for their body weight. Variability of symptoms can also lead to a misguided diagnosis. Young patients not uncommonly present with symptoms of appendicitis that fall outside the “classical presentation” of an inflamed appendicitis. And—overall—ED settings are more inclined to misdiagnosis than other healthcare settings, especially when children are being treated in adult-gauged EDs.
In this study, researchers looked closely at patients who had visited the ED and returned within seven days with their care resulting in a case review for missed diagnosis. The numbers looked like this:
- Of 29,398 children with appendicitis, 429 were misdiagnosed
- There were 5366 patients diagnosed with DKA, of which 33 were misdiagnosed
- The research identified 46 misdiagnosed patients out of 3622 who had been diagnosed with sepsis
Researchers found that patients who were not correctly diagnosed with appendicitis or DKA fared worse in 90-day complications than those with a missed diagnosis of sepsis. Children who suffered a delayed diagnosis of appendicitis were at greater risk for a perforated appendicitis, abdominal abscess, extended treatment, and readmissions. For those with initial-onset DKA, the consequences of a delayed diagnosis were severe in some cases—mechanical ventilation, cerebral edema, and death.
The study authors encourage facilities and providers to recognize the dire concern of missed diagnosis in conditions of this type and to implement measures to prevent failure to diagnose. Overall? Any patient who suffers a missed diagnosis—especially of an emergent condition—is at risk.
If you or a family member are injured through delayed or incorrect diagnosis—speak with a member of our legal team.
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