Recognition and Description of Diagnostic Error Among Pediatric Readmissions

Background: The epidemiology of hospital-based pediatric diagnostic error (DE) has not been well described. The contribution of DE to pediatric hospital readmissions is unknown. Characterization of pediatric DE is critical to developing targeted improvement approaches. We sought to describe the incidence and patterns of DE among pediatric patients hospitalized on the general pediatric service at an urban freestanding children’s hospital between 10/1/2018 and 9/30/2020 and readmitted within 15 days of discharge.

Methods: Each admission/readmission encounter was independently reviewed by two pediatric physicians using a validated diagnostic error identification instrument (SaferDx). Cases in which one or both reviewers identified DE were reviewed using the modified DEER Taxonomy to characterize points of failure in the diagnostic process. Interrater reliability in identifying DE will be evaluated.

Results: We reviewed 348 cases of 321 unique patients. In 44 cases (12.7%) one or both reviewers identified DE. Preliminary analysis of the first 9 cases showed that cardiac, airway, and infectious conditions were most frequently misdiagnosed. Diagnoses associated with DE included missed endocarditis, cardiac shunt, laryngeal cleft, tracheal stenosis, osteoarticular infection, Clostridium difficile colitis, anti-MOG encephalitis, methylmalonic acidemia, and hyperventilation syndrome. Analysis by DEER taxonomy revealed that failure points occurred during the history, hypothesis generation, and testing steps in the diagnostic process (see Figure).

Conclusion: Among pediatric patients who experienced readmission there were missed opportunities for making a timely or accurate diagnosis in 12.7% of cases. Evaluating general pediatric readmissions may be helpful in identifying DE among children and serving as a feasible strategy for identifying opportunities to improve pediatric diagnosis.

Presenting Author(s)

Morgan Congdon, MD, MPH
Pediatric Hospitalist
Department of Pediatrics, Children’s Hospital of Philadelphia
Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed

Co-Author(s)

BC
Bryn Carroll, MD
Pediatric Hospitalist
CHOP
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed
AC
Anna Costello, MD
Pediatric Hospitalist
CHOP
University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed
WC
Winona Chua, MD
Attending Physician
CHOP
Gladwyne, Pennsylvania
Disclosure: Passage Bio (Products/Services: Consultant: assess videos of children doing developmental tasks) (Consultant)
VF
Victoria Fairchild, MD
Attending Physician
CHOP
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed
Yasaman Fatemi, MD
Fellow of Pediatric Infectious Diseases
CHOP
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed
MG
Morgan E. Greenfield, MD
Pediatric Hospitalist Attending
CHOP
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed
DH
Daniel Herchline, MD, MSEd
Pediatric Hospitalist
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio
Disclosure: No Financial Relationships Disclosed
AH
Alex Howard, DO
Pediatric Hospitalist
CHOP
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed
CL
Courtney Lamberton, MD
Attending Physician
Division of General Internal Medicine, Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed
LM
Lisa McAndrew, MD
Pediatric Hospitalist
CHOP
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed
JH
Jessica Hart, MD
Pediatric Hospitalist
CHOP
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed
KS
Kathy Shaw, MD
Attending Physician
Department of Pediatrics, Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed

Senior Author(s)

IR
Irit R. Rasooly, MD, MSCE
Instructor of Pediatrics
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed