Author:
Leulseged Haleluya,A. Rees Chris,Alemu Addisu,A. Tippett Barr Beth,Dheresa Merga,Madrid Lola,Scott Anthony,Assefa Nega
Abstract
Abstract
Background
Diagnostic autopsy is the most reliable approach to definitively ascertain the cause of death and evaluate the accuracy of antemortem clinical diagnoses. Identifying diagnostic discrepancies is vital to understanding common gaps in antemortem clinical diagnoses and modifying antemortem diagnostic approaches to increase the accuracy of clinical diagnosis. The objective of this study was to determine the frequency of diagnostic discrepancies between antemortem clinical diagnoses and postmortem autopsies on lung pathologies and to understand the reasons for diagnostic discrepancies among cases included in Child Health and Mortality Prevention Surveillance (CHAMPS) in Ethiopia.
Methods
A clinical case series study of deaths among children under-five in the CHAMPS study at three sites in Ethiopia between October 2019 and April 2022 was conducted. The antemortem clinical diagnoses and postmortem pathological diagnoses of the lung were compared for each case. Two senior physicians assessed the findings for both agreement and disagreement. McNemar’s test was used to assess for statistically significant differences between antemortem and postmortem diagnoses.
Results
Seventy-five cases were included (73.3% male). Over half (54.7%) died between the 1st and 7th day of life. Sepsis (66.7%), pneumonia (6.7%), and meconium aspiration syndrome (5.0%) were the most common immediate causes of death. Half (52%) of cases were correctly diagnosed antemortem. The magnitude of diagnostic discrepancy was 35% (95% CI: 20-47%). The most common contributing factors to diagnostic discrepancy were gaps in knowledge (22/75, 35.5%) and problems in consultation and teamwork (22/75, 35.5%).
Conclusions
Misdiagnoses were common among young children who died with positive lung pathology findings. In-service education initiatives and multidisciplinary collaboration are needed to mitigate high rates of diagnostic discrepancies among young children to potentially prevent future deaths.
Publisher
Springer Science and Business Media LLC
Reference36 articles.
1. Neale G, Hogan H, Sevdalis N. Misdiagnosis: analysis based on case record review with proposals aimed to improve diagnostic processes. Clin Med. 2011;11:317.
2. Diagnostic Errors More Common, Costly And Harmful Than Treatment Mistakes – 04/23/2013. https://www.hopkinsmedicine.org/news/media/releases/diagnostic_errors_more_common_costly_and_harmful_than_treatment_mistakes. Accessed 21 Jun 2023.
3. Thébaud B, Goss KN, Laughon M, Whitsett JA, Abman SH, Steinhorn RH et al. Bronchopulmonary dysplasia. Nature Reviews Disease Primers 2019 5:1. 2019;5:1–23.
4. Alam R, Cheraghi-Sohi S, Panagioti M, Esmail A, Campbell S, Panagopoulou E. Managing diagnostic uncertainty in primary care: a systematic critical review. BMC Fam Pract. 2017;18:1–13.
5. Lee CS, Nagy PG, Weaver SJ, Newman-Toker DE, Cs L, Pg N et al. Cognitive and System Factors Contributing to Diagnostic Errors in Radiology. 2013;201:611–7.https://doi.org/10.2214/AJR1210375.