Table 1

Research approaches used to estimate the incidence of diagnostic error

Research approachFindings—examplesSuitable for evaluating incidenceSuitable for evaluating aetiology
AutopsiesMajor unexpected discrepancies that would have changed the management are found in 10–20%8 9YesNo
Patient and provider surveysOne-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 month11LimitedLimited
Standardised patientsInternists misdiagnosed 13% of patients presenting with common conditions to clinic (COPD, RA, others)12YesYes
Second reviews10–30% of breast cancers are missed on mammography13; 1–2% of cancers are misread on biopsy samples14YesNo
Diagnostic testing auditsErrors related to laboratory testing are the most common reason for a diagnostic error15 16Very limitedLimited
Malpractice claimsProblems relating to diagnostic error are the leading cause for paid malpractice suits in every large systemVery limitedLimited
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.19YesLimited
Voluntary reports1674 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 reported20YesYes
  • COPD, chronic obstructive pulmonary disease; RA, rheumatoid arthritis.