Table 2.

At-risk categories of harmful diagnostic errors

High-risk area	Disease	Additional considerations
Infections	Viral infections	Often misdiagnosed as bacterial and result in unnecessary antibiotics
	Pneumonia, dehydration from diarrhoea and malaria	Diagnoses of children often suboptimal, particularly with less well-trained healthcare workers41
	Malaria	Key presenting features (eg, fever) not specific42
	Tuberculosis	Lack of careful use of basic diagnostics result in almost 10% being misdiagnosed.43 Failure to diagnose has important public health implications. Also occur from misinterpretation of test results and failure to use basic diagnostic tools (microbiology or imaging)44
Cardiovascular disease	Myocardial infarction, stroke	Ranks high in malpractice claims37 and autopsy studies45 Subtle premonitory symptoms at first-contact settings often missed Delays in diagnosis prevalent in predisposing conditions, including type 2 diabetes (median delay >2 years; 7% remained undiagnosed at 7.5 years) and hypertension46–48
Cancer	Several cancer types49–54	Alarm symptoms often poorly predictive,55 low signal-to-noise ratio. Cancer can be in differential of many common symptoms including headache, weight loss, bleeding, pain Almost a third of colorectal and lung cancer diagnoses have missed opportunities despite ‘red flags’ (abnormal faecal occult blood, microcytic anaemia and abnormal imaging)19 20 Referral of patients with suspected cancer for confirmatory testing challenging due to poor access or cost Challenges of overdiagnosis emerge when incidental findings relentlessly pursued
Paediatrics	Claims study56 suggests meningitis, gastroenteritis, pneumonia, appendicitis, sepsis and malignancy	Misdiagnoses may contribute to the nearly 7 million children who die each year, largely from preventable causes57
	Meningococcal disease58	Half of children misdiagnosed at the first physician contact largely because presenting symptoms were non-specific
	Viral illnesses diagnosed as bacterial, medication side effects, appendicitis and psychiatric disorders30	More than half of surveyed paediatricians reported making a diagnostic error at least once or twice a month, and harmful errors at least once or twice a year
	Hypertension, problems with referrals and follow-up of abnormal laboratory values59	Primary care paediatricians who were surveyed expressed high interest in trying to improve common sub-critical errors vs errors in less common acute situations