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Errors common in diagnosis of spinal epidural abscesses despite available clinical data

09 Aug 2017

There are frequent errors in diagnosis of spinal epidural abscesses that involve inadequate history, physical examination and test ordering despite wide availability of clinical data, according to a study.

To identify missed opportunities in diagnosis of spinal epidural abscesses and outline areas for process improvement, researchers identified all patients with a new diagnosis of spinal epidural abscess using a large national clinical data repository during 2013.

Retrospective chart reviews were conducted on 250 randomly selected patients, whose records were assessed for red flags (eg, unexplained weight loss, neurological deficits and fever) 90 days prior to diagnosis. Diagnostic errors referred to missed opportunities to evaluate red flags in a timely or appropriate manner.

Information obtained included process breakdowns related to patient factors, the patient-provider encounter, test performance and interpretation, test follow-up and tracking, and the referral process. Harm and time lag between red flags and definitive diagnoses were also determined.

There were 119 patients with a new diagnosis of spinal epidural abscess, of whom 66 (55.5 percent) had diagnostic error. Median time to diagnosis in error cases was 12 days compared with 4 days in cases without error (p<0.01).

The most common red flags not evaluated in error cases were unexplained fever (n=57; 86.4 percent), focal neurological deficits with progressive or disabling symptoms (n=54; 81.8 percent), and active infection (n=54; 81.8 percent).

Most errors involved breakdowns during the patient-provider encounter (n=60; 90.1 percent), including failures in information gathering/integration. In addition, these errors were associated with temporary harm (n=43; 65.2 percent).

According to researchers, solutions should include renewed attention to basic clinical skills.

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