Preventable diagnostic errors of lower gastrointestinal perforation: a secondary analysis of a large-scale multicenter retrospective study.

Autor: Harada T; Division of General Medicine, Nerima Hikarigaoka Hospital, 2-11-1 Hikarigaoka Nerima-ku, Tokyo, 179-0072, Japan. hrdtaku@gmail.com.; Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan. hrdtaku@gmail.com., Watari T; General Medicine Center, Shimane University Hospital, Enya‑cho, Shimane, Japan., Watanuki S; Division of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan., Kushiro S; Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan., Miyagami T; Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan., Syusa S; Department of General Medicine, Tone Chuo Hospital, Numata, Gunma, Japan., Suzuki S; Department of General Medicine, Tone Chuo Hospital, Numata, Gunma, Japan., Hiyoshi T; General Medicine of Department, Faculty of Medicine, Fukuoka University, Fukuoka, Japan., Hasegawa S; Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan., Nabeshima S; General Medicine of Department, Faculty of Medicine, Fukuoka University, Fukuoka, Japan., Aihara H; Department of General Medicine, Saga University Hospital, Saga, Japan., Yamashita S; Department of General Medicine, Saga University Hospital, Saga, Japan., Tago M; Department of General Medicine, Saga University Hospital, Saga, Japan., Yoshimura F; Department of General Medicine, Kumamoto Medical Center, Kumamoto, Japan., Kunitomo K; Department of General Medicine, Kumamoto Medical Center, Kumamoto, Japan., Tsuji T; Department of General Medicine, Kumamoto Medical Center, Kumamoto, Japan., Hirose M; Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan., Tsuchida T; Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan., Shimizu T; Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan.
Jazyk: angličtina
Zdroj: International journal of emergency medicine [Int J Emerg Med] 2024 Dec 20; Vol. 17 (1), pp. 192. Date of Electronic Publication: 2024 Dec 20.
DOI: 10.1186/s12245-024-00781-4
Abstrakt: Background: Lower gastrointestinal perforation (LGP) is an acute abdominal condition associated with a high mortality rate. Timely and accurate diagnosis is crucial. Nevertheless, a diagnostic delay has been estimated to occur in approximately one-third of the cases, and the factors contributing to this delay are yet to be clearly understood. This study aimed to evaluate the diagnostic process for appropriate clinical reasoning and availability of image interpretation in cases of delayed diagnosis of LGP.
Methods: A secondary data analysis of a large multicenter retrospective study was conducted. This descriptive study analyzed data from a multicenter, observational study conducted across nine hospitals in Japan from January 2015 to December 2019. Out of 439 LGP cases, we included 138 cases of delayed diagnosis, excluding patients with traumatic or iatrogenic perforations, or those secondary to mesenteric ischemia, appendicitis, or diverticulitis. Clinical history and computed tomography (CT) imaging information were collected for 138 cases. Additionally, information on the clinical course of 50 cases, which were incorrectly diagnosed as gastroenteritis, constipation, or small bowel obstruction, was also collected.
Results: In 42 (30.4%) cases of delayed diagnosis of LGP, CT imaging was performed before diagnosis, indicating a missed opportunity for timely diagnosis. Moreover, 33 of the 50 patients initially diagnosed with gastroenteritis, constipation, or small bowel obstruction at the time of initial examination had atypical findings that were not consistent with the initial diagnosis. Of the 138 cases with delayed diagnosis in our study, 67 cases (48.6%) showed problems with either the interpretation of CT scans or with the process of clinical reasoning.
Conclusion: Our retrospective study results indicate that approximately half of the cases with delayed diagnosis of LGP were due to problems in interpreting CT images or in clinical reasoning. This finding suggests that clinical reasoning and image interpretation by radiologists are important in improving the diagnostic process for LGP.
Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the ethical review board of Showa University Koto Toyosu Hospital (No. 20T7044) and conducted in accordance with the Declaration of Helsinki. Written informed consent was waived owing to the retrospective study design by the ethical review board of Showa University Koto Toyosu Hospital. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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