Evidence map›Paper›PMID 36952085›Full record

ArticleJournal of general internal medicine2023

Prevalence and Causes of Diagnostic Errors in Hospitalized Patients Under Investigation for COVID-19.

Andrew D Auerbach, Gopi J Astik, Kevin J O'Leary, Peter N Barish, Molly A Kantor, Katie R Raffel, Sumant R Ranji, Stephanie K Mueller, Sharran N Burney, Janice Galinsky and 29 more

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Article in Journal of general internal medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Review
  5. Review
  6. Article
  7. Article
  8. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

39 authors.

Andrew D AuerbachDivision of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. ada@medicine.ucsf.edu.ORCID 0000-0001-8440-0527
Gopi J AstikDivision of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Kevin J O'LearyDivision of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Peter N BarishDivision of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Molly A KantorDivision of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Katie R RaffelDivision of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Sumant R RanjiDivision of Hospital Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
Stephanie K MuellerHospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
Sharran N BurneyBrigham and Women's Faulkner Hospital, Boston, MA, USA.
Janice GalinskyBrigham and Women's Faulkner Hospital, Boston, MA, USA.
Esteban F GershanikHospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
Abhishek GoyalHospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
Pooja R ChitneniHospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
Sarah RastegarBrigham and Women's Faulkner Hospital, Boston, MA, USA.
Armond M EsmailiDivision of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Cynthia FentonDivision of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Anunta VirapongseDivision of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Li-Kheng NgovDivision of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Marisha BurdenDivision of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Angela KenistonDivision of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Hemali PatelDivision of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Ashwin B GuptaDivision of Hospital Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
Jeff RohdeDivision of Hospital Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
Ruby MarrDivision of Hospital Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
S Ryan GreysenSection of Hospital Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Michele FangSection of Hospital Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Pranav ShahSection of Hospital Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Frances MaoSection of Hospital Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Farah KaiksowDivision of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, WI, Madison, USA.
David SterkenDivision of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, WI, Madison, USA.
Justin J ChoiDepartment of Medicine, Weill Cornell Medical College, New York, NY, USA.
Jigar ContractorDepartment of Medicine, Weill Cornell Medical College, New York, NY, USA.
Abhishek KarwaDivision of Hospital Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
David ChiaDivision of Hospital Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
Tiffany LeeDivision of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Colin C HubbardDivision of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Judith MaselliDivision of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Anuj K DalalHospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
Jeffrey L SchnipperHospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.

Funding

Utility of Predictive Systems to identify Inpatient Diagnostic Errors: The UPSIDE StudyR01HS027369 · AHRQ · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI AUERBACH, ANDREW D · 2019 to 2021
$1.5M
Development and assessment of an HIV disclosure intervention for men in UgandaK23MH126771 · NIMH · BRIGHAM AND WOMEN'S HOSPITAL · PI Pooja Rao Chitneni · 2022 to 2026
$964k
AHRQ HHS R01 HS027369NIMH NIH HHS K23 MH126771
6 · The paper itself

Abstract

backgroundThe COVID-19 pandemic required clinicians to care for a disease with evolving characteristics while also adhering to care changes (e.g., physical distancing practices) that might lead to diagnostic errors (DEs).

objectiveTo determine the frequency of DEs and their causes among patients hospitalized under investigation (PUI) for COVID-19.

designRetrospective cohort.

settingEight medical centers affiliated with the Hospital Medicine ReEngineering Network (HOMERuN). TARGET POPULATION: Adults hospitalized under investigation (PUI) for COVID-19 infection between February and July 2020. MEASUREMENTS: We randomly selected up to 8 cases per site per month for review, with each case reviewed by two clinicians to determine whether a DE (defined as a missed or delayed diagnosis) occurred, and whether any diagnostic process faults took place. We used bivariable statistics to compare patients with and without DE and multivariable models to determine which process faults or patient factors were associated with DEs.

resultsTwo hundred and fifty-seven patient charts underwent review, of which 36 (14%) had a diagnostic error. Patients with and without DE were statistically similar in terms of socioeconomic factors, comorbidities, risk factors for COVID-19, and COVID-19 test turnaround time and eventual positivity. Most common diagnostic process faults contributing to DE were problems with clinical assessment, testing choices, history taking, and physical examination (all p < 0.01). Diagnostic process faults associated with policies and procedures related to COVID-19 were not associated with DE risk. Fourteen patients (35.9% of patients with errors and 5.4% overall) suffered harm or death due to diagnostic error. LIMITATIONS: Results are limited by available documentation and do not capture communication between providers and patients.

conclusionAmong PUI patients, DEs were common and not associated with pandemic-related care changes, suggesting the importance of more general diagnostic process gaps in error propagation.

Indexed as

COVID-19AdultCOVID-19 TestingDiagnostic ErrorsHumansPandemicsPrevalenceRetrospective Studies

Identifiers

PMID36952085
PMCPMC10035474

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Textfull text, public
LicenceCC BY
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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.