Nationwide questionnaire survey on diagnostic errors in pediatric outpatient acute care.

Background: Diagnostic errors are harmful and occur at unacceptably high rates. However, data regarding diagnostic errors in pediatric populations, particularly in acute outpatient care settings, remain insufficient. This study aimed to investigate the frequency of diagnostic errors, contributing factors, common symptoms, initial diagnoses, and final diagnoses in pediatric outpatient acute care in Japan and clarify the challenges that should be prioritized for preventing such errors.

Methods: A secondary analysis of the Nationwide Survey on Diagnostic Errors in Pediatric Outpatient Acute Care questionnaire data was performed.

Results: In total, 1511 responses were received from the members of the Japan Pediatric Society. Cognitive factors, particularly insufficient information gathering, were identified as the primary contributors to diagnostic errors. Situational factors such as high workload and limited time were prominent factors, particularly in clinics. Among the most memorable cases of diagnostic errors, the chief complaints at the initial visit were frequently fever, abdominal pain, and vomiting. The common initial diagnoses included gastroenteritis, upper respiratory infection, and lower respiratory infection, whereas the final diagnoses were appendicitis, encephalitis/encephalopathy, and intussusception. Diagnostic errors with poor outcomes frequently involved final diagnoses of encephalitis/encephalopathy, myocarditis, and testicular torsion.

Conclusions: Caution should be exercised to avoid diagnostic errors when addressing the chief complaints and initial diagnoses frequently identified in this study. Diseases listed as final diagnoses should be prioritized in the differential diagnoses. Addressing the factors contributing to diagnostic errors, along with increased awareness and targeted strategies for differential diagnosis, may reduce diagnostic errors and improve healthcare quality.