Diagnostic errors in older patients: a secondary analysis of case reports.

IF 2 Q2 MEDICINE, GENERAL & INTERNAL

Diagnosis Pub Date : 2025-09-16 DOI:10.1515/dx-2025-0073

Kotaro Kunitomo, Yukinori Harada, Takashi Watari, Taku Harada, Taro Shimizu

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引用次数: 0

Abstract

Objectives: Diagnostic errors are a significant source of patient harm and occur more frequently in older adults due to comorbidities, symptom ambiguity, and communication barriers. However, how these errors differ between older and younger patients remains unclear. The aim of this study was to examine the characteristics of diagnostic errors in older patients using published case reports.

Methods: We performed a secondary analysis of 534 case reports from a systematic review. Cases were divided into older (≥65 years, n=115) and younger (<65 years, n=419) groups. Data were extracted and coded using the diagnostic error evaluation and research (DEER), reliable diagnosis challenges (RDC), and generic diagnostic pitfalls (GDP) frameworks.

Results: Older patients had significantly more DEER codes per case than younger patients (2.5 vs. 2.0; p=0.01). Key DEER codes were more frequent in older adults, including "Physical examination: Failure in weighing" (7.8 vs. 2.9 %), "Assessment: Failure/delay in considering the diagnosis" (74.8 vs. 64.0 %), and "Assessment: Failure/delay to recognise/weigh urgency" (7.8 vs. 2.9 %). In RDC, "Diagnosis of complications" was also more common in older patients (11.3 vs. 5.3 %). No significant differences were found in GDP coding.

Conclusions: Diagnostic errors involving failure to consider the correct diagnosis, recognize urgency, and identify complications were more common in older patients. Understanding these mechanisms is essential to develop diagnostic strategies specific to older patients.

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老年患者的诊断错误：病例报告的二次分析。

目的：诊断错误是患者伤害的一个重要来源，由于合并症、症状模糊和沟通障碍，在老年人中更常见。然而，这些错误在老年和年轻患者之间有何不同尚不清楚。本研究的目的是利用已发表的病例报告来检查老年患者诊断错误的特征。方法：我们对来自系统评价的534例病例报告进行了二次分析。病例分为老年（≥65 岁，n=115）和年轻(结果：老年患者的每例DEER代码明显多于年轻患者（2.5 vs. 2.0; p=0.01）。关键的DEER代码在老年人中更常见，包括“体检：称重失败”（7.8比2.9 %），“评估：考虑诊断失败/延迟”（74.8比64.0 %），以及“评估：识别/称重紧急失败/延迟”（7.8比2.9 %）。在RDC中，“并发症诊断”在老年患者中也更为常见（11.3 vs. 5.3 %）。在GDP编码方面没有发现显著差异。结论：诊断错误包括未能考虑正确诊断、认识紧迫性和识别并发症在老年患者中更为常见。了解这些机制对于制定针对老年患者的诊断策略至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diagnosis MEDICINE, GENERAL & INTERNAL-

CiteScore

7.20

自引率

5.70%

发文量

期刊介绍： Diagnosis focuses on how diagnosis can be advanced, how it is taught, and how and why it can fail, leading to diagnostic errors. The journal welcomes both fundamental and applied works, improvement initiatives, opinions, and debates to encourage new thinking on improving this critical aspect of healthcare quality.　 Topics: -Factors that promote diagnostic quality and safety -Clinical reasoning -Diagnostic errors in medicine -The factors that contribute to diagnostic error: human factors, cognitive issues, and system-related breakdowns -Improving the value of diagnosis – eliminating waste and unnecessary testing -How culture and removing blame promote awareness of diagnostic errors -Training and education related to clinical reasoning and diagnostic skills -Advances in laboratory testing and imaging that improve diagnostic capability -Local, national and international initiatives to reduce diagnostic error