Diagnostic Errors in Tuberculous Patients: A Multicenter Study from a Developing Country

Abstract

Although there is still much to learn about the types of errors committed in health care and why they occur, enough is known today to recognize that a serious concern exists for patients. Tuberculosis (TB) is an infectious disease that is frequently subject to diagnostic errors. Missed or delayed diagnosis of TB can affect patients and community adversely. Our aim in the present study was at evaluating the type of diagnostic errors in TB patients from symptom onset to diagnosis. This was a multicenter cross-sectional study conducted in three university hospitals in Mashhad, Iran. We showed a long delay in diagnosing TB that is mostly related to the time from first medical visit to diagnosis. Errors in the diagnostic process were identified in 97.5% of patients. The most common type of error in diagnosing TB was failure in hypothesis generation (72%), followed by history taking and physical examination. In conclusion, it seems likely that efforts to improve public awareness of and health literacy for TB, to coordinate the referral and follow-up systems of patients, and to improve physicians' skills in history taking and physical examination and clinical reasoning will result in reduced delay in diagnosis of TB and, perhaps, improved patient safety and community health.

Errors in Diagnosing Infectious Diseases: A Physician Survey

“…TB, as a highly contagious and potentially fatal infectious disease, was among the most common infectious diseases that were missed or diagnosed with delay. Although TB is endemic in Iran and the results of our study may not be representative of all other countries, previous studies also emphasized the challenge of misdiagnosis and delayed diagnosis of TB patients (25,26). Missed or delayed diagnosis of TB can be catastrophic because it affects patients and the community through delayed treatment, the increased period of infectivity, increased transmission of disease, and increased medical costs and mortality (27).…”

“…Experienced physicians are aware of the limitations of the intuitive approach. Thus, when it is appropriate, they try to "slow down" and devote more time to analyze available clinical and para-clinical data (25). An important point regarding the impact of errors in diagnosing infectious diseases is that they not only affect the patients but also the community health.…”

“…Experienced physicians are aware of the limitations of the intuitive approach. Thus, when it is appropriate, they try to “slow down” and devote more time to analyze available clinical and para-clinical data ( 25 ).…”

Oral Anti-Tuberculosis Drugs: An Urgent Medication Reconciliation at Hospitals in Indonesia

“…Sometimes under-diagnosis occurs because of failure to test for TB or diagnostic tests that are not sufficiently sensitive or specific to ensure accurate identification of tuberculosis cases when people go to health facilities. 4 This situation arises not only because of the nonspecific TB signs and symptoms that were undiagnosed, 5 delayed, 6 or transmitted, but also because of unfinished, [7][8][9] unrecorded, and abruptly abandoned treatments. All these may occur when the patients are seeking the care of other healthcare facilities.…”

Diagnosing active tuberculosis in primary care

“…Of the 10 million people who develop active tuberculosis (TB) disease each year, approximately three million are not identified by national TB care programmes and many are undiagnosed 1. Diagnostic delays are common in both low and high resource settings2 and lead to worse individual outcomes and ongoing transmission 34. Patients often see several healthcare providers before the disease is diagnosed 56.…”