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Here’s a concise bullet-point gist of the article you shared:
Exploring the Dark Side of the Moon: Diagnostic Errors in Critically Ill Patients
Authors: Andreas Valentin, Hans Flaatten, Martin W. Dünser
Published: 2025, Open Access, Critical Care Medicine
Definition
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Diagnostic error: Missed opportunity to make a correct or timely diagnosis.
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In critically ill patients, errors include delayed, missed, or incorrect diagnoses, often leading to patient harm.
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Critical illness is time-sensitive; delays can significantly affect outcomes.
Incidence and Impact
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In 2,428 hospitalized adults, 23% experienced diagnostic errors; 17.8% caused harm or death.
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Systematic review: 19% of critically ill patients had major missed diagnoses; ~1/3 could have affected survival if diagnosed earlier.
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General medical inpatients: diagnostic error rate ~0.7%.
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High error rate in ICU due to:
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Complex, rapidly evolving conditions
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Non-specific clinical signs
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Limitations in patient history taking
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Errors can lead to:
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Overuse of resources
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Increased mortality
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Delayed recovery
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Chronic critical illness
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Risk Factors and Causes
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Patient-related: High disease severity, atypical symptoms, altered mental status, mechanical ventilation, low health literacy, socioeconomic disadvantages.
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Cognitive factors:
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Anchoring bias
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Availability bias
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Premature closure
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Confirmation bias
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Overconfidence or knowledge gaps
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System factors:
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Poor communication
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Inadequate follow-up
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Suboptimal electronic health record design
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Syndromic approaches (e.g., sepsis, ARDS, delirium) lacking specificity
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Other contributors: Stress, fatigue, focus on procedures over basic diagnostic methods, overreliance on labs/tests.
Preventive Strategies
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Cognitive-focused:
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Teach critical thinking and bias recognition
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Encourage broad, symptom-based differential diagnoses
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System-focused:
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Adequate ICU staffing
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Diagnostic checklists
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Standardized handoffs
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Multi-disciplinary case reviews / second opinions
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Post-ICU follow-up clinics for feedback
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Structured review tools: Revised Safer Dx Instrument, DEER taxonomy
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Technology:
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AI-driven clinical decision support to reduce bias and support differential diagnosis
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Culture:
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Promote a non-blaming safety culture in ICUs
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Key Takeaways
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Diagnostic errors are common, harmful, and preventable in critically ill patients.
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Prevention requires combined cognitive, system, and technological interventions.
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Despite technological advances, diagnostic error rates remain unchanged, highlighting the need for continuous vigilance and systemic improvements.
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AI is likely to play an increasingly important role in supporting accurate diagnosis.
If you want, I can also create a one-page visual “infographic-style” summary for faster reference. This could be especially useful for ICU teams or medical students. Do you want me to do that?
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