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

Naderi, H. and Sheybani, F. and Khosravi, O. and Jabbari Nooghabi, M. (2018) Frequency of Different Types of Diagnostic Errors in Patients with Central Nervous System Infections: A Cross-Sectional Observational Study. Neurology Research International, 2018.

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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. © 2018 HamidReza Naderi et al.

Item Type: Article
Additional Information: Export Date: 16 February 2020 Correspondence Address: Sheybani, F.; Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical SciencesIran; email: fereshtesheybani@gmail.com
Uncontrolled Keywords: antibiotic agent steroid adolescent adult aged allergic encephalitis anamnesis antibiotic therapy Article bacterial meningitis brain abscess brucellosis Candida meningitis carcinomatous meningitis central nervous system infection clinical decision making clinical examination clinical outcome consciousness level controlled study cross-sectional study diagnostic error female headache herpes simplex encephalitis hospital admission human inappropriate prescribing major clinical study male medical record review meningoencephalitis observational study patient referral physical examination sinusitis steroid therapy subdural empyema thrombophlebitis tuberculous meningitis virus meningitis
Subjects: WC Communicable Diseases
WL Nervous system
Divisions: Mashhad University of Medical Sciences
Depositing User: lib2 lib2 lib2
Date Deposited: 08 May 2020 15:05
Last Modified: 08 May 2020 15:05
URI: http://eprints.mums.ac.ir/id/eprint/17436

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