ArticleBMJ quality & safety2022
Use of e-triggers to identify diagnostic errors in the paediatric ED.
Article in BMJ quality & safety, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Feasibility of Pediatric Diagnostic Quality Measurement in All United States Hospitals.Annals of emergency medicine · 2026Article
- Epidemiology of diagnostic errors in pediatric emergency departments using electronic triggers.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2025Article
- Implementation of Electronic Triggers to Identify Diagnostic Errors in Emergency Departments.JAMA internal medicine · 2025Article
- Opportunities for Diagnostic Improvement Among Pediatric Hospital Readmissions.Hospital pediatrics · 2023Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundDiagnostic errors (DxEs) are an understudied source of patient harm in children rarely captured in current adverse event reporting systems. Applying electronic triggers (e-triggers) to electronic health records shows promise in identifying DxEs but has not been used in the emergency department (ED) setting.
objectivesTo assess the performance of an e-trigger and subsequent manual screening for identifying probable DxEs among children with unplanned admission following a prior ED visit and to compare performance to existing incident reporting systems. DESIGN/
methodsRetrospective single-centre cohort study of children ages 0-22 admitted within 14 days of a previous ED visit between 1 January 2018 and 31 December 2019. Subjects were identified by e-trigger, screened to identify cases where index visit and hospital discharge diagnoses were potentially related but pathophysiologically distinct, and then these screened-in cases were reviewed for DxE using the SaferDx Instrument. Cases of DxE identified by e-trigger were cross-referenced against existing institutional incident reporting systems.
resultsAn e-trigger identified 1915 unplanned admissions (7.7% of 24 849 total admissions) with a preceding index visit. 453 (23.7%) were screened in and underwent review using SaferDx. 92 cases were classified as likely DxEs, representing 0.4% of all hospital admissions, 4.8% among those selected by e-trigger and 20.3% among those screened in for review. Half of cases were reviewed by two reviewers using SaferDx with substantial inter-rater reliability (Cohen's κ=0.65 (95% CI 0.54 to 0.75)). Six (6.5%) cases had been reported elsewhere: two to the hospital's incident reporting system and five to the ED case review team (one reported to both).
conclusionAn e-trigger coupled with manual screening enriched a cohort of patients at risk for DxEs. Fewer than 10% of DxEs were identified through existing surveillance systems, suggesting that they miss a large proportion of DxEs. Further study is required to identify specific clinical presentations at risk of DxEs.
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