Research approaches used to estimate the incidence of diagnostic error
| Research approach | Findings—examples | Suitable for evaluating incidence | Suitable for evaluating aetiology |
|---|---|---|---|
| Autopsies | Major unexpected discrepancies that would have changed the management are found in 10–20%8 9 | Yes | No |
| Patient and provider surveys | One-third of patients relate a diagnostic error that affected themselves, a family member, or close friend10; Over half the surveyed paediatricians report making a diagnostic error at least once or twice a month11 | Limited | Limited |
| Standardised patients | Internists misdiagnosed 13% of patients presenting with common conditions to clinic (COPD, RA, others)12 | Yes | Yes |
| Second reviews | 10–30% of breast cancers are missed on mammography13; 1–2% of cancers are misread on biopsy samples14 | Yes | No |
| Diagnostic testing audits | Errors related to laboratory testing are the most common reason for a diagnostic error15 16 | Very limited | Limited |
| Malpractice claims | Problems relating to diagnostic error are the leading cause for paid malpractice suits in every large system | Very limited | Limited |
| Case reviews (cross-sectional studies by symptom, disease, or condition); (may be enriched by trigger tools) | Patients with asthma—median delay in making the correct diagnosis was 3 years, or 7 visits17; 12–51% of patients with subarachnoid haemorrhage are misdiagnosed in the emergency department.18 Of 1000 hospital deaths, 5% were considered preventable, and the most frequent aetiology was diagnostic error.19 | Yes | Limited |
| Voluntary reports | 1674 reports of diagnostic error were submitted to the UK's National Reporting and Learning System over a 2-year period, 0.5% of all incidents reported20 | Yes | Yes |
COPD, chronic obstructive pulmonary disease; RA, rheumatoid arthritis.