scholarly journals Errors in Differential Diagnosis of Burn Injury at the Prehospital Stage

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.

scholarly journals Should electronic differential diagnosis support be used early or late in the diagnostic process? A multicentre experimental study of Isabel

2021 ◽  
pp. bmjqs-2021-013493
Author(s):  
Matt Sibbald ◽  
Sandra Monteiro ◽  
Jonathan Sherbino ◽  
Andrew LoGiudice ◽  
Charles Friedman ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Emergency Medicine ◽  
Differential Diagnosis ◽  
Correct Diagnosis ◽  
Diagnostic Errors ◽  
Chief Complaint ◽  
Diagnostic Process ◽  
Early Use ◽  
Complete History ◽  
Diagnostic Support

BackgroundDiagnostic errors unfortunately remain common. Electronic differential diagnostic support (EDS) systems may help, but it is unclear when and how they ought to be integrated into the diagnostic process.ObjectiveTo explore how much EDS improves diagnostic accuracy, and whether EDS should be used early or late in the diagnostic process.Setting6 Canadian medical schools. A volunteer sample of 67 medical students, 62 residents in internal medicine or emergency medicine, and 61 practising internists or emergency medicine physicians were recruited in May through June 2020.InterventionParticipants were randomised to make use of EDS either early (after the chief complaint) or late (after the complete history and physical is available) in the diagnostic process while solving each of 16 written cases. For each case, we measured the number of diagnoses proposed in the differential diagnosis and how often the correct diagnosis was present within the differential.ResultsEDS increased the number of diagnostic hypotheses by 2.32 (95% CI 2.10 to 2.49) when used early in the process and 0.89 (95% CI 0.69 to 1.10) when used late in the process (both p<0.001). Both early and late use of EDS increased the likelihood of the correct diagnosis being present in the differential (7% and 8%, respectively, both p<0.001). Whereas early use increased the number of diagnostic hypotheses (most notably for students and residents), late use increased the likelihood of the correct diagnosis being present in the differential regardless of one’s experience level.Conclusions and relevanceEDS increased the number of diagnostic hypotheses and the likelihood of the correct diagnosis appearing in the differential, and these effects persisted irrespective of whether EDS was used early or late in the diagnostic process.

Can conversation analytic findings help with differential diagnosis in routine seizure clinic interactions?

2016 ◽  
Vol 12 (1) ◽  
pp. 13-24 ◽  
Author(s):  
Katie Ekberg ◽  
Markus Reuber
Keyword(s):  
Differential Diagnosis ◽  
Correct Diagnosis ◽  
Diagnostic Errors ◽  
Epileptic Seizures ◽  
Routine Clinical Setting ◽  
Choice Of Treatment ◽  
Transient Loss ◽  
Factual Content ◽  
Patient’S History ◽  
Linguistic Methods

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.

scholarly journals SPECIFIC MOMENTS IN THE DIAGNOSTICS OF UTERINE ADNEXA TORSION IN A 15-YEAR OLD GIRL

2019 ◽  
Vol 23 (3) ◽  
pp. 154-156
Author(s):  
L. V. Adamyan ◽  
E. V. Sibirskaya ◽  
S. M. Sharkov ◽  
A. K. Fayzulin ◽  
Anastasia V. Vechernina
Keyword(s):  
Abdominal Pain ◽  
Clinical Picture ◽  
Ovarian Tumor ◽  
Inflammatory Process ◽  
Preventive Measures ◽  
Correct Diagnosis ◽  
Diagnostic Errors ◽  
Pain Syndrome ◽  
Differential Diagnostics ◽  
Adnexal Torsion

Currently, differential diagnostics and treatment of uterine adnexal torsion (UAT) in girls is not completely solved and is not an easy one because surgical and gynecological pathologies often intersect with each other. That is why, girls with abdominal pain are to be consulted by a gynecologist. The case discussed in the article demonstrates the problem with differential diagnostics in girls with “acute abdomen”. UAT differential diagnostics is not easy because this pathology has no clear clinical picture what complicates putting a correct diagnosis. UAT in girls is an acute pathology which has to be differentiated from the volume tumor-like formations in the ovaries, a frequent complication of which is an incomplete torsion of tumor leg or ovarian tumor which then leads to complete uterine adnexa torsion. Differential diagnostics should be done with other surgical pathologies such as acute appendicitis, omentum infiltration. Their clinical picture is characterized by a certain complex of symptoms which develops specific changes during the progress of the inflammatory process; this picture also depends on the anatomical peculiarities. Uterine adnexa torsion is met in 15-25% of girls with abdominal pain syndrome. The aim of this work is to demonstrate preventive measures so as to avoid possible diagnostic errors and complications associated with them in girls with abdominal pain syndrome.

scholarly journals Polymorbidity: a View on Combined Pathology

2019 ◽  
Vol 26 (5) ◽  
pp. 125-134
Author(s):  
Marina M. Tlish ◽  
Taisiya G. Kuznetsova ◽  
Zhanna Yu. Naatyzh ◽  
Ruzana M. Tikeeva
Keyword(s):  
Life Quality ◽  
Diagnostic Errors ◽  
Optimal Solution ◽  
Diagnostic Algorithm ◽  
Final Diagnosis ◽  
Healthcare Services ◽  
Differential Diagnostics ◽  
Diagnostic Process ◽  
Clinical Cases

Aim. To describe clinical cases exhibiting a rare combination of dermatoses in one patient in order to prevent iatrogenic errors.Results. The present article describes clinical cases of patients with polymorbid pathologies, which constitutes one of the current interdisciplinary healthcare problems. The described clinical cases indicate the co-occurrence and overlap of various diseases, which complicates the final diagnosis. Polymorbidity in modern patients turns the diagnostic process into a search for an optimal solution, which frequently requires innovative approaches. A mixed clinical picture leads to iatrogenic errors. A detailed differential diagnostics should be performed when establishing the final clinical diagnosis, which could reduce the frequency of medical-diagnostic and tactical errors. In this connection, a prolonged diagnostic route contributes to the timely detection of interdependent pathologies. The analysis of clinical cases related to managing patients with polymorbid pathologies facilitates the prevention of the progression of each disease, as well as the determination of prognostic aspects.Conclusion. Considering the narrow specialisation of medical institutions, the management of patients with polymorbid pathologies is a challenging problem. The management of such patients requires adherence to a clear clinical diagnostic algorithm and a multidisciplinary approach, which allows diagnostic errors and complications associated with drug therapy to be avoided, thus improving the quality of healthcare services. Polymorbid pathology constitutes an interdisciplinary problem requiring the development of a unified procedure for the management of patients, which should be aimed at the early detection of combined pathology, eliminating polypharmacy, reducing the overall risk of diseases and improving the life quality of patients.

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

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.

scholarly journals EXPERIENCE OF USING DIGITAL SYSTEMS FOR DIAGNOSTICS OF HYPERTROPHIC SKIN SCARS OF FACE

2018 ◽  
pp. 13-16
Author(s):  
D.S. Avetikov ◽  
O.P. Bukhanchenko ◽  
I.O. Ivanytsky ◽  
N.A. Sokolova ◽  
I.V. Boyko
Keyword(s):  
Differential Diagnosis ◽  
Head And Neck ◽  
Hypertrophic Scar ◽  
Digital Images ◽  
Diagnostic Errors ◽  
Morphological Structure ◽  
Quantitative Information ◽  
Differential Diagnostics ◽  
Hypertrophic Scars ◽  
Actual Problem

The relevance of the problem. Head and neck scars resulting from the effects of various endogenous and exogenous factors are an actual problem of modern surgical stomatology. A large number of scientific researches devoted to the study of different methods of diagnosis of head and neck scars indicates that the verification of the diagnosis is a highly complicated issue. Currently, conventional algorithms for selecting methods of treating patients with scars are available. The development of such algorithm is difficult due to the uncertainty of criteria for the differential diagnosis of various types of scars. Despite significant pathogenetic and morphological differences of scarring, some of their types often have clinically similar features, resulting in a significant number of diagnostic errors. In its turn, carrying out the treatment without taking into account the clinical and morphological structure of scars usually leads to the lack of tangible therapeutic effect, recurrence and increased growth of scar tissue. That is why the development of a clear algorithm of comprehensive examination of this category of patients is of particular importance for determining the tactics of their treatment. The aim of the research is to increase the effectiveness of face scars treatment due to identification of type of scar-modified tissue by means of method of digital visualization of graphic digital images. Objects and methods of the research. Fifty patients with hypertrophic scars of face were examined. Further analysis of the structure of hypertrophic scars was performed using RGB-method of visualisation. At present, computer digital image research is widely used in histological, cytological, pathologic and immunological studies, which led us to consider the use of digital analysis of images as the initial stage of primary diagnosis in various types of postoperative scarred facial tissues. Computer imaging is still the only source for obtaining visualized qualitative and quantitative information and preserving it in digital form. Results of the research. We have studied the distribution of color constants of red, green and blue colors in 4 points: T1 – the area of intact skin, T2 – the medial and T3 – the lateral edge of the scar, and T4 – the area of the middle zone of scar. Due to the proposed method, the features of architectonic layers of the skin in the area of hypertrophic scar have been studied in detail. The obtained results allow improving the differential diagnosis of scars and expanding the possibilities to develop the pathogenetically grounded treatment of patients with head and neck scars. The analysis of the results of digital visualization of graphic digital images showed that statistically reliable differences in digital indices, being observed during visualization of hypertrophic scars, could be an important criterion of their differential diagnostics. Conclusion. Thus, examination of patients with scars of the maxillofacial region, providing the RGB-method, is an effective method of non-invasive diagnosis of hypertrophic scars allowing to evaluate the changes in scar-modified tissues in dynamics. The authors substantiated the feasibility of the use of RGB-system for the improvement of differential diagnosis of hypertrophic scars of the head and neck. Due to the proposed method, features of architectonic layers of the skin in the area of hypertrophic scar have been studied in detail. The obtained results allow to improve the differential diagnosis of scars and expand the possibilities of developing pathogenetically grounded treatment of patients with scarring of the head and neck.

The Patient/Provider Relationship in Emergency Medicine

2018 ◽  
pp. 74-105
Author(s):  
Julita Soczywko ◽  
Dorota Rutkowska
Keyword(s):  
Emergency Medicine ◽  
Interpersonal Communication ◽  
Communication Skills ◽  
Emergency Care ◽  
Work Experience ◽  
Critical Role ◽  
Diagnostic Process ◽  
Emergency Nurses ◽  
Emergency Medical ◽  
Decisive Action

Emergency medicine is a rapidly developing medical specialty which focuses on the diagnostic process, initial stabilization, and the treatment of patients suffering from acute illnesses or injuries. Emergency care can be provided in prehospital settings by emergency medical services, as well as in emergency departments. The primary providers of emergency care are: emergency medicine physicians, emergency nurses, and paramedics. Emergency medical personnel are required to be prepared to take decisive action at any time of day or night. It is essential for them to possess basic knowledge relating to psychology and an ability to utilize interpersonal communication skills. A critical role of medical workers in emergency settings is to provide a patient with emotional support coupled with medical assistance. Interpersonal communication skills depend on the personal abilities of an individual, however, these skills can be also enhanced through training and work experience.

Using computerized virtual cases to explore diagnostic error in practicing physicians

Diagnosis ◽  
2018 ◽  
Vol 5 (4) ◽  
pp. 229-233
Author(s):  
Robert L. Trowbridge ◽  
James B. Reilly ◽  
Jerome C. Clauser ◽  
Steven J. Durning
Keyword(s):  
Correct Diagnosis ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Outcome Data ◽  
Diagnostic Process ◽  
Patient Harm ◽  
Physician Performance ◽  
Two Phases ◽  
Adaptive Nature ◽  
Practicing Physicians

Abstract Background Diagnostic errors are a significant cause of patient harm. Cognitive processes often contribute to diagnostic errors but studying and mitigating the effects of these errors is challenging. Computerized virtual patients may provide insight into the diagnostic process without the potential for patient harm, but the feasibility and utility of using such cases in practicing physicians has not been well described. Methods We developed a series of computerized virtual cases depicting common presentations of disease that included contextual factors that could result in diagnostic error. Cases were piloted by practicing physicians in two phases and participant impressions of the case platform and cases were recorded, as was outcome data on physician performance. Results Participants noted significant challenges in using the case platform. Participants specifically struggled with becoming familiar with the platform and adjusting to the non-adaptive and constraining processes of the model. Although participants found the cases to be typical presentations of problems commonly encountered in practice, the correct diagnosis was identified in less than 33% of cases. Conclusions The development of virtual patient cases for use by practicing physicians requires substantial resources and platforms that account for the non-linear and adaptive nature of reasoning in experienced clinicians. Platforms that are without such characteristics may negatively affect diagnostic performance. The novelty of such platforms may also have the potential to increase cognitive load. Nonetheless, virtual cases may have the potential to be a safe and robust means of studying clinical reasoning performance.

scholarly journals Prevalence and characterisation of diagnostic error among 7-day all-cause hospital medicine readmissions: a retrospective cohort study

2020 ◽  
Vol 29 (12) ◽  
pp. 971-979 ◽  
Author(s):  
Katie E Raffel ◽  
Molly A Kantor ◽  
Peter Barish ◽  
Armond Esmaili ◽  
Hana Lim ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Correct Diagnosis ◽  
Diagnostic Errors ◽  
Hospital Medicine ◽  
Diagnostic Error ◽  
Diagnostic Reasoning ◽  
Diagnostic Process ◽  
Patient Morbidity

BackgroundThe prevalence and aetiology of diagnostic error among hospitalised adults is unknown, though likely contributes to patient morbidity and mortality. We aim to identify and characterise the prevalence and types of diagnostic error among patients readmitted within 7 days of hospital discharge.MethodsRetrospective cohort study at a single urban academic hospital examining adult patients discharged from the medical service and readmitted to the same hospital within 7 days between January and December 2018. The primary outcome was diagnostic error presence, identified through two-physician adjudication using validated tools. Secondary outcomes included severity of error impact and characterisation of diagnostic process failures contributing to error.ResultsThere were 391 cases of unplanned 7-day readmission (5.2% of 7507 discharges), of which 376 (96.2%) were reviewed. Twenty-one (5.6%) admissions were found to contain at least one diagnostic error during the index admission. The most common problem areas in the diagnostic process included failure to order needed test(s) (n=11, 52.4%), erroneous clinician interpretation of test(s) (n=10, 47.6%) and failure to consider the correct diagnosis (n=8, 38.1%). Nineteen (90.5%) of the diagnostic errors resulted in moderate clinical impact, primarily due to short-term morbidity or contribution to the readmission.ConclusionThe prevalence of diagnostic error among 7-day medical readmissions was 5.6%. The most common drivers of diagnostic error were related to clinician diagnostic reasoning. Efforts to reduce diagnostic error should include strategies to augment diagnostic reasoning and improve clinician decision-making around diagnostic studies.

scholarly journals Diagnosis is a team sport – partnering with allied health professionals to reduce diagnostic errors

Diagnosis ◽  
2016 ◽  
Vol 3 (2) ◽  
pp. 49-59 ◽  
Author(s):  
Dana B. Thomas ◽  
David E. Newman-Toker
Keyword(s):  
Cultural Change ◽  
Health Professionals ◽  
Medical Diagnosis ◽  
Allied Health ◽  
Physical Therapist ◽  
Correct Diagnosis ◽  
Diagnostic Errors ◽  
Diagnostic Process ◽  
Allied Health Professionals ◽  
Sociocultural Barriers

Abstract: Diagnostic errors are the most common, most costly, and most catastrophic of medical errors. Interdisciplinary teamwork has been shown to reduce harm from therapeutic errors, but sociocultural barriers may impact the engagement of allied health professionals (AHPs) in the diagnostic process.: A qualitative case study of the experience at a single institution around involvement of an AHP in the diagnostic process for acute dizziness and vertigo. We detail five diagnostic error cases in which the input of a physical therapist was central to correct diagnosis. We further describe evolution of the sociocultural milieu at the institution as relates to AHP engagement in diagnosis.: Five patients with acute vestibular symptoms were initially misdiagnosed by physicians and then correctly diagnosed based on input from a vestibular physical therapist. These included missed labyrinthine concussion and post-traumatic benign paroxysmal positional vertigo (BPPV); BPPV called gastroenteritis; BPPV called stroke; stroke called BPPV; and multiple sclerosis called BPPV. As a consequence of surfacing these diagnostic errors, initial resistance to physical therapy input to aid medical diagnosis has gradually declined, creating a more collaborative environment for ‘team diagnosis’ of patients with dizziness and vertigo at the institution.: Barriers to AHP engagement in ‘team diagnosis’ include sociocultural norms that establish medical diagnosis as something reserved only for physicians. Drawing attention to the valuable diagnostic contributions of AHPs may help facilitate cultural change. Future studies should seek to measure diagnostic safety culture and then implement proven strategies to breakdown sociocultural barriers that inhibit effective teamwork and transdisciplinary diagnosis.

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