Errors in Diagnosis of Spinal Epidural Abscesses in the Era of Electronic Health Records.
Am J Med
; 130(8): 975-981, 2017 08.
Article
en En
| MEDLINE
| ID: mdl-28366427
ABSTRACT
PURPOSE:
With this study, we set out to identify missed opportunities in diagnosis of spinal epidural abscesses to outline areas for process improvement.METHODS:
Using a large national clinical data repository, we identified all patients with a new diagnosis of spinal epidural abscess in the Department of Veterans Affairs (VA) during 2013. Two physicians independently conducted retrospective chart reviews on 250 randomly selected patients and evaluated their records for red flags (eg, unexplained weight loss, neurological deficits, and fever) 90 days prior to diagnosis. Diagnostic errors were defined as missed opportunities to evaluate red flags in a timely or appropriate manner. Reviewers gathered information about process breakdowns related to patient factors, the patient-provider encounter, test performance and interpretation, test follow-up and tracking, and the referral process. Reviewers also determined harm and time lag between red flags and definitive diagnoses.RESULTS:
Of 250 patients, 119 had a new diagnosis of spinal epidural abscess, 66 (55.5%) of which experienced diagnostic error. Median time to diagnosis in error cases was 12 days, compared with 4 days in cases without error (P <.01). Red flags that were frequently not evaluated in error cases included unexplained fever (n = 57; 86.4%), focal neurological deficits with progressive or disabling symptoms (n = 54; 81.8%), and active infection (n = 54; 81.8%). Most errors involved breakdowns during the patient-provider encounter (n = 60; 90.1%), including failures in information gathering/integration, and were associated with temporary harm (n = 43; 65.2%).CONCLUSION:
Despite wide availability of clinical data, errors in diagnosis of spinal epidural abscesses are common and involve inadequate history, physical examination, and test ordering. Solutions should include renewed attention to basic clinical skills.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Dolor de Espalda
/
Absceso Epidural
/
Errores Diagnósticos
/
Registros Electrónicos de Salud
/
Salud de los Veteranos
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Female
/
Humans
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Male
/
Middle aged
País como asunto:
America do norte
Idioma:
En
Año:
2017
Tipo del documento:
Article