Preliminary Diagnostic Error of Emergency Physicians in the Emergency Department

急診室醫師的初步診斷誤差之探討

范文誌(Wen-Chih Fann) ； 周義(Chee Ghew) ； 龔嘉德(Chia-Te Kong) ； 蕭政廷(Cheng-Ting Hsiao) ； 廖訓禎(Shiumn-Jen Liaw)

《Journal of Emergency Medicine, Taiwan》 5卷4期 (2003/12) Pp. 172-180

摘要

目的：本文研究急診醫師在急診室之初步診斷能力與誤差探討。
方法：初步診斷係指病患來到急診室，經急診醫師初步病史詢問、理學檢查及進一步實驗室檢查後所作的診斷。我們回溯性病例探討從2001年9月1日至30日在急診室6個小時內住院的非外傷成人病患，共比較113人其急診室的初步診斷與病房的出院診斷，並探討診斷之誤差與原因。
結果：共6個病患有診斷誤差，誤診率為5.3%(6/113)。其中5名病患年齡介於61至82歲。而6位病患中有3人死亡。發生診斷誤差的原因包括病史與理學檢查的疏失、實驗室檢查的遺漏或判斷推理的問題。
結論：本研究發現急診醫師在急診室之初步診斷誤差仍相對較高，顯示未來仍需持續加強急診醫師訓練及改善急診工作環境，以降低誤診率。而老年病患的不典型症狀表現則增加了診斷誤差的風險。

關鍵字

診斷誤差 ； 誤診 ； 初步診斷 ； 急診室

並列摘要

Study objective: To more precisely understand the emergency physician’s diagnostic competence in order to improving quality of care in the emergency department (ED).
Methods: The preliminary diagnosis is defined as the diagnosis made after initial history taking and examinations, and before further disposition. We retrospectively reviewed the inpatient ED records of adult medical patients (non-trauma adult patients) who stayed in the ED for less than 6 hours during 1(superscript st) September to 30(superscript th). September 2001. The charts of 113 patients subsequently admitted to ward were included to study for errors in the ED. The preliminary diagnoses generated in the ED were compared with the ward discharge diagnoses. The discrepancies as well as the reasons between ED and discharge diagnoses were noted and judged.
Results: 6 cases were found to have diagnostic errors. The preliminary misdiagnosis rate generated in the ED was 5.3% (6/113). The ages of 5 of 6 cases ranged from 61 to 82. The reasons of errors appeared in 6 cases separately, including errors in history taking and physical examination (2 cases), omitting tests (2 cases), judgment or reasoning (2 cases). Half cases had mortality.
Conclusion: The preliminary misdiagnosis rate is relatively high, suggesting that measures to reduce errors, including frequently re-assessing patients in the ED and persistently improving clinical training of diagnostic workup and ED working environment, is required. Besides, the majority of misdiagnoses in the ED are from elderly patients. Atypical symptoms and signs of geriatric patients elevate the risks of medical error in the ED.

並列關鍵字

diagnostic errors ； misdiagnosis ； preliminary diagnosis ； emergency department