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Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.

Shafer GJ, Singh H, Thomas EJ, Thammasitboon S, Gautham KS. Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study. Journal of perinatology : official journal of the California Perinatal Association. 2022 Oct 1; 42(10):1312-1318.

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OBJECTIVE: To determine the frequency and etiology of diagnostic errors during the first 7 days of admission for inborn neonatal intensive care unit (NICU) patients. STUDY DESIGN: We conducted a retrospective cohort study of 600 consecutive inborn admissions. A physician used the "Safer Dx NICU Instrument" to review the electronic health record for the first 7 days of admission, and categorized cases as "yes," "unclear," or "no" for diagnostic error. A secondary reviewer evaluated all "yes" charts plus a random sample of charts in the other categories. Subsequently, all secondary reviewers reviewed records with discordance between primary and secondary review to arrive at consensus. RESULTS: We identified 37 diagnostic errors (6.2% of study patients) with "substantial agreement" between reviewers (?? = 0.66). The most common diagnostic process breakdown was missed maternal history (51%). CONCLUSION: The frequency of diagnostic error in inborn NICU patients during the first 7 days of admission is 6.2%.

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