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Deliberate Practice as an Effective Method for Reducing Diagnostic Error in Identifying Burn and Bruise Injuries Suspicious for an Abusive Injury.
Lorenzo, Melissa; Cory, Emma; Cho, Romy; Pusic, Martin; Fish, Joel; Adelgais, Kathleen M; Boutis, Kathy.
Affiliation
  • Lorenzo M; Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada.
  • Cory E; Division of Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada.
  • Cho R; Division of Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada.
  • Pusic M; Division of Pediatric Emergency Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard University, Boston, MA.
  • Fish J; Division of Plastic Surgery, Department of Surgery, Hospital for Sick Children and University of Toronto, Toronto, Canada.
  • Adelgais KM; Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
  • Boutis K; Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada. Electronic address: kathy.boutis@sickkids.ca.
J Pediatr ; 274: 114183, 2024 Nov.
Article in En | MEDLINE | ID: mdl-38964439
ABSTRACT

OBJECTIVE:

To examine the effectiveness of an education intervention for reducing physician diagnostic error in identifying pediatric burn and bruise injuries suspicious for abuse, and to determine case-specific variables associated with an increased risk of diagnostic error. STUDY

DESIGN:

This was a multicenter, prospective, cross-sectional study. A convenience sample of pediatricians and other front-line physicians who treat acutely injured children in the United States and Canada were eligible for participation. Using a web-based education and assessment platform, physicians deliberately practiced with a spectrum of 300 pediatric burn and bruise injury image-based cases. Participants were asked if there was a suspicion for abuse present or absent, were given corrective feedback after every case, and received summative diagnostic performance overall (accuracy), suspicion for abuse present (sensitivity), and absent (specificity).

RESULTS:

Of the 93/137 (67.9%) physicians who completed all 300 cases, there was a significant reduction in diagnostic error (initial 16.7%, final 1.6%; delta -15.1%; 95% CI -13.5, -16.7), sensitivity error (initial 11.9%, final 0.7%; delta -11.2%; 95% CI -9.8, -12.5), and specificity error (initial 23.3%, final 6.6%; delta -16.7%; 95% CI -14.8, -18.6). Based on 35 627 case interpretations, variables associated with diagnostic error included patient age, sex, skin color, mechanism of injury, and size and pattern of injury.

CONCLUSIONS:

The education intervention substantially reduced diagnostic error in differentiating the presence vs absence of a suspicion for abuse in children with burn and bruise injuries. Several case-based variables were associated with diagnostic error, and these data can be used to close specific skill gaps in this clinical domain.
Subject(s)
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Burns / Child Abuse / Contusions / Diagnostic Errors Limits: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male Country/Region as subject: America do norte Language: En Journal: J Pediatr Year: 2024 Document type: Article Affiliation country: Canada Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Burns / Child Abuse / Contusions / Diagnostic Errors Limits: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male Country/Region as subject: America do norte Language: En Journal: J Pediatr Year: 2024 Document type: Article Affiliation country: Canada Country of publication: United States