The global burden of diagnostic errors in primary care

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 Defining diagnostic errors
A diagnostic error occurs when a patient's diagnosis is missed altogether, inappropriately delayed and/or wrong, as judged by the eventual appreciation of definitive information10 but these categories of missed, delayed and wrong overlap extensively.

A survey of 600 US PCPs identified typical concerns, such as settling too rapidly on a diagnosis, failing to consider an appropriately broad differential diagnosis or failing to order appropriate tests or consultations.39

  High-risk situations

Studies on the relative frequency of conditions involved are largely from high-income countries. Reviews of diagnostic errors encountered in ambulatory care settings suggest that diagnostic errors may derive from routine as well as infrequent/rare conditions. Some of the conditions described in a systematic review included malignancies, myocardial infarction, meningitis, dementia, iron deficiency anaemia, asthma, tremor in the elderly and HIV.6 The observational study of 190 cases of diagnostic errors12 described earlier found that the most commonly encountered conditions involved pneumonia (6.7%), decompensated congestive heart failure (5.7%), acute renal failure (5.3%), cancer (5.3%) and urinary tract infection or pyelonephritis (4.8%).

  In a US study of 181 malpractice claims, cancer was the most common diagnosis involved.37 An analysis of 1000 negligent claims against the UK general practitioners identified diagnostic errors most commonly involving infections, trauma and cancer.40

 Table 2

At-risk categories of harmful diagnostic errors