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Diagnostic error in the Emergency Department: follow up of patients with minor trauma in the outpatient clinic

Overview of attention for article published in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, February 2017
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  • In the top 25% of all research outputs scored by Altmetric
  • Good Attention Score compared to outputs of the same age (74th percentile)
  • Above-average Attention Score compared to outputs of the same age and source (62nd percentile)

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Title
Diagnostic error in the Emergency Department: follow up of patients with minor trauma in the outpatient clinic
Published in
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, February 2017
DOI 10.1186/s13049-017-0361-5
Pubmed ID
Authors

Pieter-Jan Moonen, Luc Mercelina, Willem Boer, Tom Fret

Abstract

The Emergency Department (ED) is prone to diagnostic error. Most frequent diagnostic errors involved "minor" trauma. Our goal was to determine how frequently a missed diagnosis was detected during follow up and to determine the frequency and causes of primary missed diagnosis and diagnostic error. A retrospective single centre study review, during 6 months including all patients presenting to the outpatient clinic after ED admission with a minor trauma. We defined primary missed diagnosis versus diagnostic error. Demographic data were collected in Excel file and analyzed using Χ(2) and unpaired T-test. Inclusion of 56 patients leading to 57 missed diagnoses representing 1.39% of all minor trauma patients presenting to the ED. History and physical examination notes were incomplete or inadequate in respectively 17/56 and 20/56. Most frequently missed diagnoses were ankle (13/57), wrist (8/57) and foot (7/57) fractures. Causes for diagnostic error could be categorized into two main groups: failure to perform adequate history taking and/or physical examination and failure to order or correctly interpret technical investigation. In 6 cases (0.14%) diagnostic error was confirmed. All other cases were defined as primary missed diagnosis. Emergency physicians have to remain vigilant to prevent and avoid primary missed diagnosis (PMD) and diagnostic error (DE), certainly in case of minor trauma patients, representing a large proportion of ED patients. We observed a prevalence of 1.39% of missed diagnoses within a six month study period. This is comparable to previous studies (1% ). However in our study both primary missed diagnoses and DE were included. Using this definition we saw that only one case could be attributed to negligence and DE had a prevalence of 0.14% (6 cases). X-rays remain the mainstay investigation for minor trauma patients, however in certain selected cases (pelvic and spinal trauma) we advise early CT-scan.Follow up in an outpatient clinic or other forms of planned follow up have to be provided and help to reduce PMD and DE. Both primary missed diagnosis and diagnostic error have relatively low prevalence but have a serious impact on patients, hospitals and medical services. Planned follow up after adequate explanation can help to prevent diagnostic error and detect primary missed diagnosis, thereby reducing time to final diagnosis and risks for medico legal litigation. Reassessment of diagnostic error on a timely basis can be used as a key performance indicator in a quality assessment program.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 88 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Australia 1 1%
Unknown 87 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 10 11%
Other 8 9%
Student > Bachelor 8 9%
Researcher 8 9%
Student > Ph. D. Student 6 7%
Other 16 18%
Unknown 32 36%
Readers by discipline Count As %
Medicine and Dentistry 27 31%
Nursing and Health Professions 9 10%
Computer Science 3 3%
Engineering 3 3%
Agricultural and Biological Sciences 2 2%
Other 9 10%
Unknown 35 40%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 6. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 11 November 2019.
All research outputs
#5,546,457
of 22,953,506 outputs
Outputs from Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
#474
of 1,263 outputs
Outputs of similar age
#106,736
of 428,391 outputs
Outputs of similar age from Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
#13
of 35 outputs
Altmetric has tracked 22,953,506 research outputs across all sources so far. Compared to these this one has done well and is in the 75th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,263 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 10.2. This one has gotten more attention than average, scoring higher than 62% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 428,391 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 74% of its contemporaries.
We're also able to compare this research output to 35 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 62% of its contemporaries.