Pediatric clinicians self-report making diagnostic errors resulting in harm at least once or twice annually.1,2 National data corroborate pediatric clinicians’ experiences. For example, the Child Health Patient Safety Organization reported that missed diagnostic opportunities (MDOs) constituted the greatest proportion of care management errors contributing to serious safety events among their member hospitals.3 Similarly, MDOs represent the most common medical factor contributing to pediatric closed (i.e., settled) malpractice claims.4 Given these findings, pediatric patient safety leaders have placed MDOs in the top 10 patient safety research priorities.5
The epidemiology of MDOs for specific pediatric diagnoses (e.g., appendicitis, child abuse, cancer) has long been a focus of pediatric research, particularly in tertiary children’s hospitals.6-11 Less exploration has occurred in community hospitals that deliver acute care to the vast majority of children.12 Hospital-based research into MDOs also focuses on relatively acute presentations.
In contrast, conditions commonly managed in the primary care setting (e.g., hypertension, depression, anemia) have an added challenge in quantifying MDOs for illnesses that evolve over time.13 While early efforts to detect and understand MDOs in pediatric medicine are encouraging and necessary, our understanding of the unique issues in pediatric diagnostic safety is embryonic.
This issue brief explores the unique challenges of studying and improving diagnostic safety for children with respect to their overall health, access to care, and unique aspects of diagnostic testing limitations for many pediatric conditions. The issue brief will also highlight approaches to address these challenges across the care delivery spectrum: primary care offices, emergency departments (EDs), inpatient wards, and intensive care units. The brief concludes with recommendations for building capacity to advance pediatric diagnostic safety.
