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Endokrynologia Polska 2020Thyroid hormones and thyroid-stimulating hormone (TSH) laboratory tests are commonly used worldwide, and their results have an important influence on decisions about... (Review)
Review
Thyroid hormones and thyroid-stimulating hormone (TSH) laboratory tests are commonly used worldwide, and their results have an important influence on decisions about treatment and further diagnostic processes. Any discrepancies between symptoms and laboratory results or between results of different tests should be closely investigated to avoid misdiagnosis and unnecessary treatment. Inconsistencies in hormone tests might be a result of physiological changes in hormonal balance, a disease, drug intake, or laboratory interference. Major factors that interfere with thyroid function tests are: heterophilic antibodies, macro TSH, biotin, thyroid hormones autoantibodies, anti-streptavidin, and anti-ruthenium antibodies. In this paper we discuss the influence of different factors on the procedures of hormonal immunoassays, as well as methods to minimise the risk of false results and misdiagnoses.
Topics: Diagnostic Errors; Humans; Hyperthyroidism; Immunoassay; Thyroid Function Tests; Thyrotropin; Thyroxine; Triiodothyronine
PubMed: 33378071
DOI: 10.5603/EP.a2020.0079 -
The Journal of Clinical Psychiatry Oct 2015Bipolar depression is difficult to diagnose and is often mistaken for unipolar depression. Unfortunately, this misdiagnosis creates a cascade of negative outcomes.... (Review)
Review
Bipolar depression is difficult to diagnose and is often mistaken for unipolar depression. Unfortunately, this misdiagnosis creates a cascade of negative outcomes. Patients will probably receive inadequate or inappropriate treatment that will not alleviate the symptoms or impairment of the disorder and may even further destabilize their mood. These individuals are then at risk for experiencing numerous social and occupational impairments, alcohol or substance abuse, and suicidal behavior. An accurate diagnosis and appropriate treatment of bipolar disorder are necessary to prevent this chain of potentially disastrous events.
Topics: Bipolar Disorder; Diagnostic Errors; Humans; Treatment Failure
PubMed: 26528666
DOI: 10.4088/JCP.14016tx2c -
Neurology Jan 2019Misdiagnosis of multiple sclerosis (MS) (the incorrect assignment of a diagnosis of MS) remains a problem in contemporary clinical practice. Studies indicate that... (Review)
Review
Misdiagnosis of multiple sclerosis (MS) (the incorrect assignment of a diagnosis of MS) remains a problem in contemporary clinical practice. Studies indicate that misdiagnosed patients are often exposed to prolonged unnecessary health care risks and morbidity. The recently published 2017 revision of the McDonald criteria for the diagnosis of MS provides an opportunity to consider the effect of these revisions on the problem of MS misdiagnosis. The 2017 McDonald criteria include several new recommendations to reduce potential for misdiagnoses. The criteria should be used for the types of patients in which validation studies were performed, specifically those patients who present with typical demyelinating syndromes. MRI lesion characteristics were defined for which McDonald criteria would be expected to perform with accuracy. However, 2017 revisions, which now include assessment for cortical lesions, and the inclusion of symptomatic lesions and positive oligoclonal bands for the fulfillment of diagnostic criteria, may have the potential to lead to misdiagnosis of MS if not applied appropriately. While the 2017 McDonald criteria integrate issues relating to MS misdiagnosis and incorporate specific recommendations for its prevention more prominently than prior criteria, the interpretation of clinical and radiologic assessments upon which these criteria depend will continue to allow misdiagnoses. In patients with atypical clinical presentations, the revised McDonald criteria may not be readily applied. In those situations, further evaluation or monitoring rather than immediate diagnosis of MS is prudent.
Topics: Diagnostic Errors; Humans; Magnetic Resonance Imaging; Multiple Sclerosis; Neurologic Examination; Oligoclonal Bands
PubMed: 30381369
DOI: 10.1212/WNL.0000000000006583 -
Ugeskrift For Laeger Sep 2022Diagnostic bias is when biased considerations along with inadequate individual thought patterns result in a misdiagnosis. It is a constant and challenging issue in all... (Review)
Review
Diagnostic bias is when biased considerations along with inadequate individual thought patterns result in a misdiagnosis. It is a constant and challenging issue in all medical specialties. There is evidence that knowledge of diagnostic bias will enhance physicians' diagnostic abilities. This review finds that there are several effective strategies to reduce the risk of diagnostic bias. Cognitive models such as dual-process-theory and tools such as metacognition can help the clinician in their assessment of the patient.
Topics: Bias; Diagnostic Errors; Humans; Physicians
PubMed: 36178180
DOI: No ID Found -
Current Neurology and Neuroscience... Apr 2022To highlight potential avenues to reduce preventable diagnostic error of neuro-ophthalmic conditions and avoid patient harm. (Review)
Review
PURPOSE OF REVIEW
To highlight potential avenues to reduce preventable diagnostic error of neuro-ophthalmic conditions and avoid patient harm.
RECENT FINDINGS
Recent prospective studies and studies of patient harm have advanced our understanding. Additionally, recent studies of fundus photography, telemedicine, and artificial intelligence highlight potential avenues for diagnostic improvement. Diagnostic error of neuro-ophthalmic conditions can often be traced to failure to gather an adequate history, perform a complete physical exam, obtain adequate/appropriate neuroimaging, and generate a complete, appropriate differential diagnosis. Improving triage and identification of neuro-ophthalmic conditions by other providers and increasing access to subspecialty neuro-ophthalmology evaluation are essential avenues to reduce diagnostic error. Further research should evaluate the relationship between misdiagnosis and patient harm, and help identify the most impactful potential targets for improvement.
Topics: Artificial Intelligence; Diagnostic Errors; Eye Diseases; Humans; Neurology; Ophthalmology
PubMed: 35320466
DOI: 10.1007/s11910-022-01189-4 -
Ugeskrift For Laeger Apr 2023Sound diagnostic reasoning is a defining characteristic of the expert clinician. The prevailing psychological model of reasoning describes two systems of thought: a... (Review)
Review
Sound diagnostic reasoning is a defining characteristic of the expert clinician. The prevailing psychological model of reasoning describes two systems of thought: a fast, intuitive, but biased (System 1) and a rigorous, analytic, but slow (System 2). Clinicians use both systems during diagnostic reasoning but tend to lean toward a System 1-dominant approach as they get more experienced. This represents a potential source of diagnostic error, perhaps amenable to deliberate System 2 thinking. In this review, first principles reasoning is suggested as a method of System 2 thinking in a diagnostic context. .
Topics: Humans; Thinking; Problem Solving; Diagnostic Errors; Models, Psychological
PubMed: 37114578
DOI: No ID Found -
Skeletal Radiology Aug 2022Acute calcific periarthritis (ACP) is a self-limiting, monoarticular, peri-articular process of dystrophic mineral deposition and adjacent inflammation. Patients present... (Review)
Review
Acute calcific periarthritis (ACP) is a self-limiting, monoarticular, peri-articular process of dystrophic mineral deposition and adjacent inflammation. Patients present with a sudden onset of pain, localised swelling, erythema, tenderness and restricted range of motion. Symptoms reduce in severity within 4-7 days and self resolve in 3-4 weeks. ACP is commonly misdiagnosed, in particular, as infective or inflammatory pathologies such as septic arthritis and gout. This condition has specific imaging findings which allows differentiation from other disorders when combined with the clinical presentation. Prompt diagnosis results in appropriate management and reduces the likelihood of unnecessary diagnostic and therapeutic procedures.
Topics: Calcinosis; Diagnostic Errors; Humans; Pain; Periarthritis
PubMed: 35149896
DOI: 10.1007/s00256-022-04006-8 -
The Journal of Applied Laboratory... May 2020
Topics: Biotin; Diagnostic Errors; Humans; Immunoassay; Streptavidin
PubMed: 32445349
DOI: 10.1093/jalm/jfaa040 -
Australian Journal of General Practice Nov 2019Disseminated superficial actinic porokeratosis (DSAP) is a precancerous skin condition often seen by dermatologists that is characterised by multiple annular... (Review)
Review
BACKGROUND
Disseminated superficial actinic porokeratosis (DSAP) is a precancerous skin condition often seen by dermatologists that is characterised by multiple annular hyperkeratotic lesions on sun-exposed areas. In Australia, DSAP is not a rare condition, possibly owing to Australia's high levels of sun exposure, and patients with DSAP often initially present to general practitioners (GPs). A lack of awareness about DSAP may result in misdiagnosis and inappropriate management of the condition.
OBJECTIVE
The aim of this article is to provide an overview of DSAP relevant to GPs to better facilitate diagnosis, management and referral to a dermatologist.
DISCUSSION
The underlying pathophysiological mechanism of DSAP is unknown. Although there is currently no effective standardised treatment, ongoing management is warranted, given the potential for malignant transformation. Suggested strategies include frequent full skin checks, patient education about sun protection and ablative treatment (such as cryotherapy) if indicated. Suspicious lesions require excision and histopathology.
Topics: Diagnostic Errors; Humans; Porokeratosis; Precancerous Conditions; Skin
PubMed: 31722456
DOI: 10.31128/AJGP-04-19-4914 -
BMC Cardiovascular Disorders May 2022Spontaneous isolated superior mesenteric artery (SMA) dissection (SISMAD) is a rare disease with a potentially fatal pathology. Due to the lack of specificity of...
BACKGROUND
Spontaneous isolated superior mesenteric artery (SMA) dissection (SISMAD) is a rare disease with a potentially fatal pathology. Due to the lack of specificity of clinical characteristics and laboratory tests, misdiagnosis and missed diagnosis are often reported. Therefore, the aim of this study was to investigate the clinical characteristics and misdiagnosis of SISMAD.
METHODS
In a registry study from January 2013 to December 2020, 110 patients with SISMAD admitted to the First Affiliated Hospital of Wenzhou Medical University were enrolled. Descriptive methods were used to analyse clinical characteristics, laboratory data, diagnostic method or proof, misdiagnosed cases, plain computed tomography (CT) findings and dissection features. To study the relationship between dissection features and treatment modality, the selected patients were classified into the conservative group (n = 71) and the non-conservative group (n = 39). The Chi-square test and Student's t-test were used to compare the conservative and non-conservative groups.
RESULTS
One hundred ten patients with SISMAD, including 100 (90.9%) males and 10 (9.1%) females, with a mean age of 52.4 ± 7.6 years, were enrolled in the study. Relevant associated comorbidities included a history of hypertension in 43 cases (39.1%), smoking in 46 cases (41.8%), and alcohol consumption in 34 cases (30.9%). One hundred four patients (94.5%) presented with abdominal pain. Abnormalities in the C-reactive protein lever, white blood cells count and D-dimer lever were the 3 most common abnormal findings. There were 32 misdiagnosis or missed diagnosis. Fourteen cases were misdiagnosed because of insufficient awareness. Twelve cases were misdiagnosed because of disease features. Twenty cases were misdiagnosed as SMA embolism. Among them, There were 15 cases of Yun type IIb SISMAD. Sixty-six patients underwent plain CT. The maximum SMA diameter was 12.1 (11.3-13.1) mm, and the maximum SMA diameter was located on the left renal vein (LRV) plane in 68.2% of cases. Dissection features observed on contrast-enhanced CT (CECT), CT angiography (CTA), or digital subtraction angiography (DSA) showed that there were 70 cases (63.6%) of Yun type IIb SISMAD, the maximum SMA diameter was 13.0 ± 2.4 mm, the location of the maximum SMA diameter was on the LRV plane in 64.5% of cases, and 7.3% of cases were complicated with intestinal obstruction, including bowel necrosis in 3.6% of cases. There were differences between the conservative group and non-conservative groups in the residual true lumen diameter or degree of true lumen stenosis and the presence of intestinal obstruction or bowel necrosis (all P < 0.05).
CONCLUSION
For SISMAD, misdiagnosis and missed diagnosis were usually caused by insufficient awareness and disease features. SISMAD should be considered in the differential diagnosis of patients presenting with unexplained abdominal pain, especially males, patients in the 5th decade of life, patients with hypertension, and patients with an enlarged SMA diameter or a maximum SMA diameter located on the LRV plane on plain CT. Mesenteric CTA or CECT should be recommended for the investigation of these conditions.
Topics: Abdominal Pain; Adult; Aortic Dissection; Diagnostic Errors; Female; Humans; Hypertension; Intestinal Obstruction; Male; Mesenteric Artery, Superior; Middle Aged; Necrosis; Retrospective Studies; Treatment Outcome
PubMed: 35610570
DOI: 10.1186/s12872-022-02676-9