ArticleBMC health services research2026
Uncovering diagnostic errors in dentistry through critical incident reports: a mixed-methods analysis.
Article in BMC health services research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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3 authors.
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Abstract
backgroundDiagnostic errors and near misses threaten patient safety in dental practice. In Sindh, the service delivery standards require documentation and review of critical incidents, supporting incident reporting as a platform for ensuring patient safety. This study aimed to describe incident patterns using critical incident reports, a structured patient safety reporting mechanism used to document adverse events, near misses, and diagnostic process failures in clinical practice.
methodsA sequential mixed-methods study reviewed 300 de-identified incident reports from Karachi from January to June 2024. Associations with urgency were assessed using chi-square or Fisher's exact tests and logistic regression analysis. Reflexive thematic analysis of narrative fields was supplemented by face-to-face interviews with 20 selected reporters.
resultsIncidents were classified as urgent in 173/300 (57.7%) cases, and corrective action was required in 289/300 (96.3%) cases. Recurrence was most commonly coded as 20-40% (148/300, 49.3%). The most frequently coded diagnostic domains were pulp diseases (87/300, 29.0%), periodontal ligament diseases (85/300, 28.3%), and temporomandibular joint disorders (80/300, 26.7%). The leading contributing factors were a lack of diagnostic resources (142/300, 47.3%), lack of postgraduate training (119/300, 39.7%), and gaps in undergraduate teaching (103/300, 34.3%). Recurrence category showed the strongest association with urgency (p < 0.001). In multivariable logistic regression, urgent classification was less likely in private clinics (aOR 0.16, p = 0.013) and among male reporters (aOR 0.37, p < 0.001) and more likely in reports filed by senior faculty (aOR 2.48, p = 0.025); the 20-29 patients/week group also had higher adjusted odds of urgency (aOR 2.26, p = 0.023). Qualitative themes highlighted incomplete assessments, limited access to and interpretation of imaging, gaps in supervision and referral pathways, and communication failures.
conclusionThe registry demonstrates recurrent, high-urgency patterns linked to resource and training constraints and supports structured critical incident reporting as a practical tool for teaching triage, escalation, and safer diagnostic workflows for safer and more effective dental care. CLINICAL TRIALS: Not applicable.
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