Frequency of Different Types of Diagnostic Errors in Patients with Central Nervous System Infections: A Cross-Sectional Observational Study

Abstract

Objectives To assess the frequency of different types of diagnostic errors in patients with central nervous system (CNS) infection from the onset of symptoms to admission to the hospital, where the correct diagnosis was made. Methods A cross-sectional observational design was used, and the information was collected by interviewing patients and/or their knowledgeable relatives as well as reviewing the accompanying medical record documents and hospital records. Results Of 169 adult patients with CNS infection, 129 (76.33%) were subject to diagnostic errors. Failure in ordering tests and hypothesis generation were the most common types of diagnostic errors that accounted for more than 70% of errors. Several contributing factors that were associated with incorrect diagnostic hypotheses included failure in taking a patient's comprehensive history such as detecting relevant epidemiological clues, conducting a full clinical examination, and interpreting diagnostic evidence. The relationship between poor clinical outcome and longer delay from the onset of illness to diagnosis, inappropriate empirical antibiotic therapy, and lower level of consciousness on admission were found to be statistically significant. Conclusions Although diagnosis and management of CNS infection in some patients are straightforward, clinical decision making in facing patients with complex scenarios often requires clinical reasoning instead of relying only on intuitive diagnosis. Justification in requesting diagnostic measures and interpretation of their results based on clinical findings and patient information could be a critical factor in preventing a substantial number of diagnostic errors in patients with CNS infection.

Errors in Diagnosing Infectious Diseases: A Physician Survey

“…As noted in previous reports on medical errors, infectious diseases are among the main categories of illnesses affected by diagnostic errors (17). Pneumonia, TB, diarrhea with dehydration, malaria, CNS infections, infective endocarditis, and abscesses were reported as the categories of infectious diseases which are more frequently prone to harmful diagnostic errors (11,15,(18)(19)(20). Benign viral infections have been reported as the most common disease categories that were affected by misdiagnosis in primary care (21).…”

“…There are several case reports and series found in the literature describing errors in diagnosing CNS infections ( 30 , 31 ). We previously highlighted a high rate of errors in the diagnosis of patients with CNS infections and the adverse impact of these errors on patients' clinical outcomes ( 19 ). Ordering appropriate tests/imaging was the most common failure in the diagnostic process of patients with community-acquired CNS infections ( 19 ).…”

“…We previously highlighted a high rate of errors in the diagnosis of patients with CNS infections and the adverse impact of these errors on patients' clinical outcomes ( 19 ). Ordering appropriate tests/imaging was the most common failure in the diagnostic process of patients with community-acquired CNS infections ( 19 ). Diagnosis of CNS infections was misdiagnosed instead of other diseases in 25% of reported cases in our study; however, missed or delayed diagnoses, or being mistaken for other diseases were reported more frequently.…”

The Use of Art Observation Interventions to Improve Medical Students’ Diagnostic Skills: A Scoping Review

“…The ability to examine a patient thoroughly and accurately is fundamental in medicine as it largely contributes to forming a clinical diagnosis. Developing diagnostic confidence and competence can help reduce diagnostic errors, which are estimated to be as high as 10-15% [4] representing the leading cause of preventable harm. Having said that, it is important to caveat that diagnostic error is often not an individual problem but a much more complex systems level issue.…”

Resolution of the expert council «The role of multiplex PCR diagnostics in optimizing treatment tactics for neuroinfections in children»

“…[1,2]. Участники круглого стола отметили, что ухудшению исходов у больных с инфекционными заболеваниями ЦНС способствует позднее обращение за медицинской помощью, неадекватное состоянию больного ведение на догоспитальном этапе, стремительное развитие критических состояний при молниеносном течении острых нейроинфекций [3,4]. Несомненно, диагностика нейроинфекционной патологии невозможна без ликворологических исследований, однако, наличие противопоказаний к проведению люмбальной пункции (ЛП), обусловленных крайней тяжестью состояния пациентов на момент поступления в стационар (отек головного мозга, нарастающая внутричерепная гипертензия, нестабильная гемодинамика и пр.…”