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Prevalence of atypical presentations among outpatients and associations with diagnostic error

  • Yukinori Harada EMAIL logo , Yumi Otaka , Shinichi Katsukura und Taro Shimizu
Veröffentlicht/Copyright: 8. Dezember 2023
Diagnosis
Aus der Zeitschrift Diagnosis Band 11 Heft 1

Abstract

Objectives

This study aimed to assess the prevalence of atypical presentations and their association with diagnostic errors in various diseases.

Methods

This retrospective observational study was conducted using cohort data between January 1 and December 31, 2019. Consecutive outpatients consulted by physicians from the Department of Diagnostic and Generalist Medicine at a university hospital in Japan were included. Patients for whom the final diagnosis was not confirmed were excluded. Primary outcomes were the prevalence of atypical presentations, and the prevalence of diagnostic errors in groups with typical and atypical presentations. Diagnostic errors and atypical presentations were assessed using the Revised Safer Dx Instrument. We performed primary analyses using a criterion; the average score of less than five to item 12 of two independent reviewers was an atypical presentation (liberal criterion). We also performed additional analyses using another criterion; the average score of three or less to item 12 was an atypical presentation (conservative criterion).

Results

A total of 930 patients were included out of a total of 2022 eligible. The prevalence of atypical presentation was 21.7 and 6.7 % when using liberal and conservative criteria for atypical presentation, respectively. Diagnostic errors (2.8 %) were most commonly observed in the cases with slight to moderate atypical presentation. Atypical presentation was associated with diagnostic errors with the liberal criterion for atypical presentation; however, this diminished with the conservative criterion.

Conclusions

An atypical presentation was observed in up to 20 % of outpatients with a confirmed diagnosis, and slight to moderate atypical presentation may be the highest risk population for diagnostic errors.

Keywords: atypical presentation; diagnostic errors; outpatient; Revised Safer Dx Instrument
Corresponding author: Yukinori Harada, MD, PhD, Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, 880 Kitakobayashi, Mibu, Shimotsugagun, Tochigi 321-0293, Japan, Phone: +81 282 86 1111, E-mail:

  1. Research ethics: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by the authors’ Institutional Review Board (The Institutional Ethics Committee of Dokkyo Medical University Hospital).

  2. Informed consent: The Institutional Ethics Committee of Dokkyo Medical University Hospital waived the requirement for written informed consent from patients because we used an opt-out method.

  3. Author contributions: YH designed the study. YH, YO, and SK collected data. YH performed the statistical analyses. YH prepared the manuscript with contributions from all co-authors. The authors applied the SDC approach for the sequence of authors. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Competing interests: Authors state no conflict of interest.

  5. Research funding: None declared.

  6. Data availability: The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/dx-2023-0060).

Received: 2023-05-19
Accepted: 2023-11-17
Published Online: 2023-12-08

© 2023 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. The physical exam and telehealth: between past and future
  4. Review
  5. Features and functions of decision support systems for appropriate diagnostic imaging: a scoping review
  6. Mini Reviews
  7. The PRIDx framework to engage payers in reducing diagnostic errors in healthcare
  8. Tumor heterogeneity: how could we use it to achieve better clinical outcomes?
  9. Original Articles
  10. Factors influencing diagnostic accuracy among intensive care unit clinicians – an observational study
  11. Prevalence of atypical presentations among outpatients and associations with diagnostic error
  12. Preferred language and diagnostic errors in the pediatric emergency department
  13. Diurnal temperature variation and the implications for diagnosis and infectious disease screening: a population-based study
  14. What’s going well: a qualitative analysis of positive patient and family feedback in the context of the diagnostic process
  15. Assessing clinical reasoning skills following a virtual patient dizziness curriculum
  16. Interleukin-6, tumor necrosis factor-α, and high-sensitivity C-reactive protein for optimal immunometabolic profiling of the lifestyle-related cardiorenal risk
  17. Effect of syringe underfilling on the quality of venous blood gas analysis
  18. Short Communications
  19. How do patients and care partners describe diagnostic uncertainty in an emergency department or urgent care setting?
  20. Enhancing clinical reasoning with Chat Generative Pre-trained Transformer: a practical guide
  21. Letters to the Editor
  22. How to overcome hurdles in holding mortality and morbidity conferences on diagnostic error cases in Japan
  23. Medical history-taking by highlighting the time course: PODCAST approach
  24. Journal Reputation Factor
  25. Case Report
  26. Pre-analytical errors in coagulation testing: a case series
  27. Acknowledgement
  28. Acknowledgement
https://doi.org/10.1515/dx-2023-0060
Schlagwörter für diesen Artikel
atypical presentation; diagnostic errors; outpatient; Revised Safer Dx Instrument

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. The physical exam and telehealth: between past and future
  4. Review
  5. Features and functions of decision support systems for appropriate diagnostic imaging: a scoping review
  6. Mini Reviews
  7. The PRIDx framework to engage payers in reducing diagnostic errors in healthcare
  8. Tumor heterogeneity: how could we use it to achieve better clinical outcomes?
  9. Original Articles
  10. Factors influencing diagnostic accuracy among intensive care unit clinicians – an observational study
  11. Prevalence of atypical presentations among outpatients and associations with diagnostic error
  12. Preferred language and diagnostic errors in the pediatric emergency department
  13. Diurnal temperature variation and the implications for diagnosis and infectious disease screening: a population-based study
  14. What’s going well: a qualitative analysis of positive patient and family feedback in the context of the diagnostic process
  15. Assessing clinical reasoning skills following a virtual patient dizziness curriculum
  16. Interleukin-6, tumor necrosis factor-α, and high-sensitivity C-reactive protein for optimal immunometabolic profiling of the lifestyle-related cardiorenal risk
  17. Effect of syringe underfilling on the quality of venous blood gas analysis
  18. Short Communications
  19. How do patients and care partners describe diagnostic uncertainty in an emergency department or urgent care setting?
  20. Enhancing clinical reasoning with Chat Generative Pre-trained Transformer: a practical guide
  21. Letters to the Editor
  22. How to overcome hurdles in holding mortality and morbidity conferences on diagnostic error cases in Japan
  23. Medical history-taking by highlighting the time course: PODCAST approach
  24. Journal Reputation Factor
  25. Case Report
  26. Pre-analytical errors in coagulation testing: a case series
  27. Acknowledgement
  28. Acknowledgement
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