1191: CLARITY OF THOUGHT BEFORE RASHNESS OF ACTION: DIFFERENTIAL DIAGNOSIS AND ICU DIAGNOSTIC ERRORS

There are many areas in medicine in which the diagnosis poses significant difficulties and depends essentially on the clinician’s ability to take and interpret the patient’s history. The differential diagnosis of transient loss of consciousness (TLOC) is one such example, in particular the distinction between epilepsy and ‘psychogenic’ non-epileptic seizures (NES) is often difficult. A correct diagnosis is crucial because it determines the choice of treatment. Diagnosis is typically reliant on patients’ (and witnesses’) descriptions; however, conventional methods of history-taking focusing on the factual content of these descriptions are associated with relatively high rates of diagnostic errors. The use of linguistic methods (particularly conversation analysis) in research settings has demonstrated that these approaches can provide hints likely to be useful in the differentiation of epileptic and non-epileptic seizures. This paper explores to what extent (and under which conditions) the findings of these previous studies could be transposed from a research into a routine clinical setting.

Download Full-text

The 6C model for accurately capturing the patient’s medical history

Diagnosis ◽

10.1515/dx-2020-0126 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Taro Shimizu

Keyword(s):

Artificial Intelligence ◽

Differential Diagnosis ◽

Patient Safety ◽

Information Processing ◽

Safety Concern ◽

Data Gathering ◽

Diagnostic Errors ◽

Accurate Diagnosis ◽

History Taking ◽

Novel Approach

Abstract Diagnostic errors are an internationally recognized patient safety concern, and leading causes are faulty data gathering and faulty information processing. Obtaining a full and accurate history from the patient is the foundation for timely and accurate diagnosis. A key concept underlying ideal history acquisition is “history clarification,” meaning that the history is clarified to be depicted as clearly as a video, with the chronology being accurately reproduced. A novel approach is presented to improve history-taking, involving six dimensions: Courtesy, Control, Compassion, Curiosity, Clear mind, and Concentration, the ‘6 C’s’. We report a case that illustrates how the 6C approach can improve diagnosis, especially in relation to artificial intelligence tools that assist with differential diagnosis.

Download Full-text

Difficulties in the differential diagnosis of tumors in the female reproductive system

Obstetrics Gynecology and Reproduction ◽

10.17749/2313-7347.2019.13.4.369-383 ◽

2020 ◽

Vol 13 (4) ◽

pp. 369-383

Author(s):

Ju. V. Nosova ◽

A. E. Solopova ◽

G. N. Khabas ◽

A. V. Asaturova

Keyword(s):

Differential Diagnosis ◽

Inflammatory Reaction ◽

Wilms Tumor ◽

Imaging Techniques ◽

Uterine Cancer ◽

Diagnostic Errors ◽

Diagnostic Tools ◽

Cytokeratin 20 ◽

Pelvic Tumors ◽

Wide Range

Introduction. Most pelvic tumors originate from reproductive organs. Even using the up-to-date imaging techniques, radiologists experience difficulties in determining the source of the lesion since a wide range of tumors look similar to each other on the distorted backdrop of pelvic anatomy, large invasive formations, and an active inflammatory reaction of the pelvic peritoneum.Aim: to evaluate “pitfalls” in the preoperative noninvasive diagnosis of female pelvic tumors by applying the clinical diagnostic tools.Materials and methods. Four rare clinical cases were analyzed; all of them posed difficulties in interpreting the diagnostic examination due to their atypical characteristics. There were 2 cases of ovarian cancer, initially identified by an experienced team of radiologists as benign pelvic pathology. Also, there were fibroids with degeneration, marked proliferative activity, and a massive inflammatory reaction of the peritoneum – that was diagnosed as a malignant ovarian tumor. Tumor biopsies were examined using morphological and immunohistochemical methods (with the р16, Ki-67, p53, CD 117, S 100, CD 34 markers). Immunohistochemical (IHC) studies were performed with formalin-fixed paraffin materials using the avidin-biotin-peroxidase method. Antibodies to estrogen receptor (ER), progesterone receptor (PR), cytokeratin 7 (CK7), cytokeratin 20 (CK20) and Wilms tumor protein 1 (WT1) were also used.Results. A thorough analysis of the clinical picture and a joint multidisciplinary discussion (gynecologist, oncologist, radiologist, etc.) made it possible to avoid diagnostic errors.Conclusion. These observations demonstrate the difficulties of differential diagnosis between ovarian metastases of uterine cancer and primary multiple ovarian and uterine cancer, as well between leiomyosarcoma and uterine myoma with high mitotic activity. Obviously, the change in diagnosis calls for a change in the treatment strategy.

Download Full-text

Dermoscopy in differentiating palmar syphiloderm from palmar papular psoriasis

International Journal of STD & AIDS ◽

10.1177/0956462417714178 ◽

2017 ◽

Vol 28 (14) ◽

pp. 1461-1463 ◽

Cited By ~ 8

Author(s):

Enzo Errichetti ◽

Giuseppe Stinco

Keyword(s):

Differential Diagnosis ◽

Diagnostic Errors ◽

Secondary Syphilis ◽

Non Invasive

Palmar syphiloderm is one of the most common presentations of secondary syphilis and its recognition is of utmost importance in order to promptly identify such a disease and initiate appropriate workup/management. However, the differential diagnosis with palmar papular psoriasis often poses some difficulties, with consequent possible diagnostic errors/delays and prescription of improper therapies. In this report, we underline the role of dermoscopy as a supportive tool to facilitate the non-invasive recognition of palmar syphiloderm and its distinction from palmar papular psoriasis.

Download Full-text

Errors in Differential Diagnosis of Burn Injury at the Prehospital Stage

Russian Sklifosovsky Journal Emergency Medical Care ◽

10.23934/2223-9022-2020-9-4-659-665 ◽

2021 ◽

Vol 9 (4) ◽

pp. 659-665

Author(s):

O. S. Pankrateva ◽

Yu. V. Yurova ◽

P. K. Krylov ◽

E. V. Zinoviev ◽

D. O. Vagner ◽

...

Keyword(s):

Differential Diagnosis ◽

Emergency Care ◽

Burn Injury ◽

Correct Diagnosis ◽

Diagnostic Errors ◽

Differential Diagnostics ◽

Diagnostic Process ◽

Medical Department ◽

Emergency Medical ◽

Inpatient Department

Relevance. An important component of the diagnostic process in combustiology is the collection of anamnesis. At the same time, verification of the very fact of a burn injury of the skin, as a rule, does not seem to be a difficult task even for a novice doctor. However, specialists from the I.I. Dzhanelidze Institute regularly encounter errors in the differential diagnosis of burn injuries at the prehospital stage on the part of both ambulance teams (EMS) and surgeons (traumatologists) of non-specialized medical institutions. Each such case attracts attention and takes up a significant part of the time resource of the entire staff of the inpatient department of the emergency medical service for the process of clarifying and verifying the correct diagnosis, as well as determining the further routing of such a patient.Aim of study. To study the structure of diagnostic errors at the prehospital stage of the EMS to optimize patient routing by improving the existing organizational and methodological standards.Material and methods. A retrospective analysis of the case histories of all victims who were admitted to the inpatient department of the Emergency Medical Department of the I.I. Dzhanelidze St. Petersburg Research Institute of Emergency Medicine during the period from January 2018 to December 2019.Results. 4,951 patients were admitted with a leading diagnosis of the referring institution, suggesting a history of burn injury. The incidence of diagnostic errors at the prehospital stage of emergency care was 410 cases (8.3%), while burn injury was completely excluded in 178 cases (3.6%).Conclusions. 1. The results of the analysis revealed a high incidence of diagnostic errors at the prehospital stage of emergency care (8.3%), the main reason for which is the lack of awareness of differential diagnostics within the narrow specialty (combustiology) of primary contact physicians. 2. Shown is the introduction of training practice for doctors and paramedics of emergency medical services, surgeons and traumatologists of primary care in combustiology cycles in specialized burn departments. 3.In order to ensure continuity in the process of providing medical care to patients with burns, it is necessary to create a unified database of convalescents to form a feedback channel with the outpatient clinic during the implementation of the rehabilitation complex.

Download Full-text

Optimization of Early Diagnostics of Prostate Cancer

Bulletin of Science and Practice ◽

10.33619/2414-2948/54/12 ◽

2020 ◽

Vol 6 (5) ◽

pp. 97-104

Author(s):

N. Stepanov ◽

Z. Duvayarov ◽

I, Bystrova ◽

T. Chepaikina ◽

V. Kostrova

Keyword(s):

Prostate Cancer ◽

Differential Diagnosis ◽

Early Diagnosis ◽

Clinical Symptoms ◽

Clinical Signs ◽

Diagnostic Errors ◽

Decay Products ◽

Examination Methods ◽

Special Examination ◽

Diagnostic Capabilities

The prevalence and incidence of prostate cancer is gradually increasing both in our country and in countries near and far abroad. The difficulties in the differential diagnosis of prostate cancer are convincingly evidenced by the fact that the level of diagnostic errors reaches 40%. It should be noted that in assessing the differential diagnostic capabilities of the indicators of the clinical and special examination methods for patients with lower urinary tract symptoms, disagreements were found in 46–77% of the analyzed clinical signs, the changes of which mainly reflect the negative nature of the effect of tumor decay products on the patient’s body. The aim of the study was to improve the early diagnosis of prostate cancer by using the mathematical method of differential diagnosis of prostate pathology, as well as the rationale for the proposed method for early diagnosis of prostate cancer in patients with clinical symptoms. Using our proposed method for early diagnosis of prostate cancer makes the diagnosis not only reliable and accurate, but also independent of the level of qualification of the urologist and his personal experience, allows you to unify, optimize and personify the differential diagnosis of prostatic hypertrophy and prostate cancer.

Download Full-text

Incidence of diagnostic errors in unplanned hospitalized patients using an automated medical history-taking system with differential diagnosis generator: retrospective observational study (Preprint)

10.2196/preprints.35225 ◽

2021 ◽

Author(s):

Ren Kawamura ◽

Yukinori Harada ◽

Shu Sugimoto ◽

Yuichiro Nagase ◽

Shinichi Katsukura ◽

...

Keyword(s):

Internal Medicine ◽

Differential Diagnosis ◽

Clinical Practice ◽

Medical History ◽

Diagnostic Errors ◽

Clinical History ◽

Final Diagnosis ◽

Outpatient Department ◽

Medical History Taking ◽

History Taking

BACKGROUND Automated medical history-taking systems that generate differential diagnosis lists have been suggested to contribute to improved diagnostic accuracy. However, the effect of this system on diagnostic errors in clinical practice remains unknown. OBJECTIVE This study aimed to assess the incidence of diagnostic errors in an outpatient department, where an artificial intelligence (AI)-driven automated medical history-taking system that generates differential diagnosis lists was implemented in clinical practice. METHODS We conducted a retrospective observational study using data from a community hospital in Japan. We included patients aged 20 and older who used an AI-driven automated medical history-taking system that generates differential diagnosis lists in the outpatient department of internal medicine for whom the index visit was between July 1, 2019, and June 30, 2020, followed by unplanned hospitalization within 14 days. The primary endpoint was the incidence of diagnostic errors, which were detected using the Revised Safer Dx instrument by at least two independent reviewers. To evaluate the differential diagnosis list of AI on the incidence of diagnostic errors, we compared the incidence of diagnostic errors between the groups in which AI generated the final diagnosis in the differential diagnosis list and in which AI did not generate the final diagnosis in the differential diagnosis list; Fisher’s exact test was used for comparison between these groups. For cases with confirmed diagnostic errors, further review was conducted to identify the contributing factors of diagnostic errors via discussion among the three reviewers, using the Safer Dx Process Breakdown Supplement as a reference. RESULTS A total of 146 patients were analyzed. The final diagnosis was confirmed in 138 patients and the final diagnosis was observed in the differential diagnosis list of the AI in 69 patients. Diagnostic errors occurred in 16 of 146 patients (11.0%; 95% confidence interval, 6.4-17.2%). Although statistically insignificant, the incidence of diagnostic errors was lower in cases in which the final diagnosis was included in the differential diagnosis list of AI than in cases in which the final diagnosis was not included (7.2% vs. 15.9%, P=.18). Regarding the quality of clinical history taken by AI, the final diagnosis was easily assumed by reading only the clinical history taken by the system in 11 of 16 cases (68.8%). CONCLUSIONS The incidence of diagnostic errors in the internal medicine outpatients used an automated medical history-taking system that generates differential diagnosis lists seemed to be lower than the previously reported incidence of diagnostic errors. This result suggests that the implementation of an automated medical history-taking system that generates differential diagnosis lists could be beneficial for diagnostic safety in the outpatient department of internal medicine.

Download Full-text

Tuberkulose im Kindesalter (Tuberculosis in Childhood)

PEDIATRICS ◽

10.1542/peds.9.5.658a ◽

1952 ◽

Vol 9 (5) ◽

pp. 658-658

Keyword(s):

Differential Diagnosis ◽

Diagnostic Errors ◽

Theory And Practice ◽

European Countries ◽

Diagnosis And Treatment ◽

Long Period ◽

Insidious Onset ◽

Two Factors ◽

Serial Films ◽

Tuberkulose Im Kindesalter

In many European countries, the investigation, diagnosis and treatment of tuberculosis has early developed into a specialty. Two factors are responsible for this historical trend. 1: The influence of pioneer discoveries on theory and practice (Koch, Roentgen, Flügge, Ghon, Fahraus). 2: The increase of tuberculosis in 2 after-war periods of starvation that enabled specialists in well-equipped sanitariums to collect long period observations, to study localisations and differential diagnosis, reinfection and insidious onset, to improve the technic of serial films and to eliminate traditional diagnostic errors.

Download Full-text

Differential diagnosis and treatment of Morton’s neuroma in ambulatory surgical practice

Ambulatory surgery hospital-replacing technologies ◽

10.21518/1995-1477-2020-1-2-89-94 ◽

2020 ◽

pp. 89-94

Author(s):

V. N. Korobkov ◽

V. A. Filippov

Keyword(s):

Differential Diagnosis ◽

Plantar Fasciitis ◽

Soft Tissues ◽

Diagnostic Errors ◽

Metatarsophalangeal Joint ◽

Diagnostic Methods ◽

Differential Diagnostics ◽

Foot Pain ◽

Morton’S Neuroma ◽

Morton's Neuroma

Introduction. Diagnosis of Mortoan neuroma in some cases does not cause much difficulty and is based on typical signs, but in some cases it presents certain difficulties. Therapeutic tactics for this disease involves the use of conservative or surgical treatment.Aim. Study of the results of differential diagnosis of Morton’s neuroma in the practice of an outpatient surgeon.Material and methods. A study of the results of diagnostics and differential diagnostics in 15 patients with chronic foot pain at the age of 28 to 46 years was conducted. Among them, there were 14 women and 1 man. Differential diagnostics for foot pain syndromes allowed us to distinguish three groups of patients. The first group included 7 patients with Morton’s neuroma. The second group included 4 patients with plantar fasciitis and the third group-4 patients with arthritis, synoviitis of the metatarsophalangeal joints. To conduct differential diagnostics, we used anamnesis, physical examination, and data from instrumental diagnostic methods.Results. Diagnosis of Morton’s neuroma was based on the use of standard research methods (anamnesis, data from a physical instrumental examination of the foot). It should be noted the importance of ultrasound examination of the soft tissues of the foot on the plantar surface for the diagnosis of Morton’s neuroma. This allows for differential diagnosis with foot diseases such as plantar fasciitis and metatarsophalangeal joint synovitis, which may show similar symptoms.Conclusion. Morton’s neuroma is not a rare disease of the foot, which in the initial stages of the disease has a blurred clinical picture, similar to other diseases of the foot. This can lead to diagnostic errors, but the use of modern diagnostic methods, including sonographic methods, allows in most cases to establish an accurate diagnosis and choose an appropriate treatment strategy.

Download Full-text

Differential diagnosis of rosacea

Russian Journal of Skin and Venereal Diseases ◽

10.17816/dv2020150-56 ◽

2020 ◽

Vol 23 (1) ◽

pp. 50-56

Author(s):

Vsevolod G. Akimov ◽

L. S. Kruglova

Keyword(s):

Differential Diagnosis ◽

Clinical Picture ◽

Clinical Signs ◽

Diagnostic Errors ◽

Skin Lesions ◽

Facial Skin ◽

Skin Erythema

The clinical picture of rosacea, including facial skin erythema, telangiectasia, and popular, and pustular elements, is similar to other dermatoses, thereby causing difficulties in the differential diagnosis. Original photos and descriptions of the clinical signs that distinguish these diseases from rosacea are provided. Therefore, the possibility of rare skin lesions that are sometimes mistaken for a more frequent pathology should be considered to avoid diagnostic errors.

Download Full-text