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Cited by 99Clinical Reasoning and Diagnostic SkillsPharmaceutical Practices and Patient OutcomesHealthcare cost, quality, practices

Diagnostic errors in older patients: a systematic review of incidence and potential causes in seven prevalent diseases

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Skinner, Thomas, Scott, Ian, Martin, Jennifer·2016·International Journal of General Medicine
DOI 10.2147/ijgm.s96741PMC PMC4881921
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Abstract

BACKGROUND: Misdiagnosis, either over- or underdiagnosis, exposes older patients to increased risk of inappropriate or omitted investigations and treatments, psychological distress, and financial burden. OBJECTIVE: To evaluate the frequency and nature of diagnostic errors in 16 conditions prevalent in older patients by undertaking a systematic literature review. DATA SOURCES AND STUDY SELECTION: Cohort studies, cross-sectional studies, or systematic reviews of such studies published in Medline between September 1993 and May 2014 were searched using key search terms of "diagnostic error", "misdiagnosis", "accuracy", "validity", or "diagnosis" and terms relating to each disease. DATA SYNTHESIS: A total of 938 articles were retrieved. Diagnostic error rates of >10% for both over- and underdiagnosis were seen in chronic obstructive pulmonary disease, dementia, Parkinson's disease, heart failure, stroke/transient ischemic attack, and acute myocardial infarction. Diabetes was overdiagnosed in <5% of cases. CONCLUSION: Over- and underdiagnosis are common in older patients. Explanations for over-diagnosis include subjective diagnostic criteria and the use of criteria not validated in older patients. Underdiagnosis was associated with long preclinical phases of disease or lack of sensitive diagnostic criteria. Factors that predispose to misdiagnosis in older patients must be emphasized in education and clinical guidelines.

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Authors
Skinner, T., Scott, I., & Martin, J.
Affiliations
  • Nambour General Hospital (AU)
  • The University of Queensland (AU)
Corresponding author
Skinner, Thomas
ORCID
Venue
International Journal of General Medicine
Publisher
Informa UK Limited
Published
2016-05
Volume
9
Pages
137
ISSN
1178-7074 (ISSN-L)
DOI
10.2147/ijgm.s96741
PMC
PMC4881921
OpenAlex
W2399462162
Cited by
99
References
4
Citations by year
2026: 9 · 2025: 13 · 2024: 9 · 2023: 13 · 2022: 9 · 2021: 7 · 2020: 7 · 2019: 11 · 2018: 11 · 2017: 9 · 2016: 1
FWCI
1.87
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of General Medicine (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
  • Figshare (submittedVersion, cc-by-nc)
  • NOVA (University of Newcastle Australia) (submittedVersion, cc-by-nc)
Topics
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
Keywords
diagnostic errors, misdiagnosis, overdiagnosis, underdiagnosis, elderly patients, chronic obstructive pulmonary disease, dementia, Parkinson's disease, heart failure, stroke, transient ischemic attack, acute myocardial infarction, diabetes mellitus, diagnostic criteria validity

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