Preventable diagnostic errors of lower gastrointestinal perforation: a secondary analysis of a large-scale multicenter retrospective study
Dublin Core
Title
Preventable diagnostic errors of lower gastrointestinal perforation: a secondary analysis of a large-scale multicenter retrospective study
Subject
Diagnostic errors, Delayed diagnosis, Gastrointestinal perforation, Abdominal pain, Clinical reasoning
Description
Abstract
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.
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.
Creator
Taku Harada1,2*, Takashi Watari3
, Satoshi Watanuki4
, Seiko Kushiro5
, Taiju Miyagami5
, Syunsuke Syusa6
, Satoshi Suzuki6
,
Tetsuya Hiyoshi7
, Suguru Hasegawa8
, Shigeki Nabeshima7
, Hidetoshi Aihara9
, Shun Yamashita9
, Masaki Tago9
,
Fumitaka Yoshimura10, Kotaro Kunitomo10, Takahiro Tsuji10, Masanori Hirose11, Tomoya Tsuchida11 and Taro Shimizu2
, Satoshi Watanuki4
, Seiko Kushiro5
, Taiju Miyagami5
, Syunsuke Syusa6
, Satoshi Suzuki6
,
Tetsuya Hiyoshi7
, Suguru Hasegawa8
, Shigeki Nabeshima7
, Hidetoshi Aihara9
, Shun Yamashita9
, Masaki Tago9
,
Fumitaka Yoshimura10, Kotaro Kunitomo10, Takahiro Tsuji10, Masanori Hirose11, Tomoya Tsuchida11 and Taro Shimizu2
Source
https://doi.org/10.1186/s12245-024-00781-4
Date
2024
Contributor
Peri Irawan
Format
PDF
Language
ENGLISH
Type
TEXT
Files
Collection
Citation
Taku Harada1,2*, Takashi Watari3
, Satoshi Watanuki4
, Seiko Kushiro5
, Taiju Miyagami5
, Syunsuke Syusa6
, Satoshi Suzuki6
,
Tetsuya Hiyoshi7
, Suguru Hasegawa8
, Shigeki Nabeshima7
, Hidetoshi Aihara9
, Shun Yamashita9
, Masaki Tago9
,
Fumitaka Yoshimura10, Kotaro Kunitomo10, Takahiro Tsuji10, Masanori Hirose11, Tomoya Tsuchida11 and Taro Shimizu2, “Preventable diagnostic errors of lower gastrointestinal perforation: a secondary analysis of a large-scale multicenter retrospective study,” Repository Horizon University Indonesia, accessed April 26, 2026, https://repository.horizon.ac.id/items/show/12543.