05 août 2022

Il est possible de réduire les erreurs de diagnostic

Background. Incorrect, delayed and missed diagnoses can contribute to significant adverse health outcomes. Intervention options have proliferated in recent years necessitating an update to McDonald et al’s 2013 systematic review of interventions to reduce diagnostic error. Objectives. (1) To describe the types of published interventions for reducing diagnostic error that have been evaluated in terms of an objective patient outcome; (2) to assess the risk of bias in the included interventions and perform a sensitivity analysis of the findings; and (3) to determine the effectiveness of included interventions with respect to their intervention type. Methods. Medline, Cinahl and the cochrane database of systematic reviews were searched from 1 January 2012 to 31 December 2019. Publications were included if they delivered patient related outcomes relating to diagnostic accuracy, management outcomes and/or morbidity and mortality. The interventions in each included study were categorised and analysed using the six intervention types described by McDonald et al (technique, technology-based system interventions, educational interventions, personnel changes, structured process changes and additional review methods). Results. Twenty studies met the inclusion criteria. Eighteen of the twenty included studies (including three randomised controlled trials (RCTs)) demonstrated improvements in objective patient outcomes following the intervention. These three RCTs individually evaluated a technique-based intervention, a technology-based system intervention and a structured process change. The inclusion or exclusion of two higher risk of bias studies did not affect the results. Conclusion. Technique-based interventions, technology-based system interventions and structured process changes have been the most studied interventions over the time period of this review and hence are seen to be effective in reducing diagnostic error. However, more high quality RCTs are required, particularly evaluating educational interventions and personnel changes, to demonstrate the value of these interventions in diverse settings.

Commentaire du Dr Marius Laurent (PAQS)

  • Nous sommes loin des querelles des théoriciens de l’erreur de diagnostic, et de la possibilité ou non d’interventions basées sur l’évitement des biais ou de l’acquisition de connaissances afin de réduire la fréquence de celles-ci. Les moyens analysés dans cette revue systématique sont essentiellement techniques et technologiques, ou systémiques (procédures), et des résultats positifs sont rapportés. Mais la question de la détection et de la quantification des erreurs de diagnostic reste ouverte.

Dave N, Bui S, Morgan C, Hickey S, Paul CL. Interventions targeted at reducing diagnostic error: systematic review. BMJ Qual Saf 2021; Doi : 10.1136/bmjqs-2020-012704.