Table 2

At-risk categories of harmful diagnostic errors

High-risk areaDiseaseAdditional considerations
InfectionsViral infectionsOften misdiagnosed as bacterial and result in unnecessary antibiotics
Pneumonia, dehydration from diarrhoea and malariaDiagnoses of children often suboptimal, particularly with less well-trained healthcare workers41
MalariaKey presenting features (eg, fever) not specific42
TuberculosisLack of careful use of basic diagnostics result in almost 10% being misdiagnosed.43 Failure to diagnose has important public health implications.
Also occur from misinterpretation of test results and failure to use basic diagnostic tools (microbiology or imaging)44
Cardiovascular diseaseMyocardial infarction, strokeRanks high in malpractice claims37 and autopsy studies45
Subtle premonitory symptoms at first-contact settings often missed
Delays in diagnosis prevalent in predisposing conditions, including type 2 diabetes (median delay >2 years; 7% remained undiagnosed at 7.5 years) and hypertension46–48
CancerSeveral cancer types49–54Alarm symptoms often poorly predictive,55 low signal-to-noise ratio. Cancer can be in differential of many common symptoms including headache, weight loss, bleeding, pain
Almost a third of colorectal and lung cancer diagnoses have missed opportunities despite ‘red flags’ (abnormal faecal occult blood, microcytic anaemia and abnormal imaging)19 20
Referral of patients with suspected cancer for confirmatory testing challenging due to poor access or cost
Challenges of overdiagnosis emerge when incidental findings relentlessly pursued
PaediatricsClaims study56 suggests meningitis, gastroenteritis, pneumonia, appendicitis, sepsis and malignancyMisdiagnoses may contribute to the nearly 7 million children who die each year, largely from preventable causes57
Meningococcal disease58Half of children misdiagnosed at the first physician contact largely because presenting symptoms were non-specific
Viral illnesses diagnosed as bacterial, medication side effects, appendicitis and psychiatric disorders30More than half of surveyed paediatricians reported making a diagnostic error at least once or twice a month, and harmful errors at least once or twice a year
Hypertension, problems with referrals and follow-up of abnormal laboratory values59Primary care paediatricians who were surveyed expressed high interest in trying to improve common sub-critical errors vs errors in less common acute situations