{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:58:41Z","timestamp":1790913521358,"version":"4.1.0"},"reference-count":43,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"vor","delay-in-days":246,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatrics International"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diagnostic errors are harmful and occur at unacceptably high rates. However, data regarding diagnostic errors in pediatric populations, particularly in acute outpatient care settings, remain insufficient. This study aimed to investigate the frequency of diagnostic errors, contributing factors, common symptoms, initial diagnoses, and final diagnoses in pediatric outpatient acute care in Japan and clarify the challenges that should be prioritized for preventing such errors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A secondary analysis of the Nationwide Survey on Diagnostic Errors in Pediatric Outpatient Acute Care questionnaire data was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 1511 responses were received from the members of the Japan Pediatric Society. Cognitive factors, particularly insufficient information gathering, were identified as the primary contributors to diagnostic errors. Situational factors such as high workload and limited time were prominent factors, particularly in clinics. Among the most memorable cases of diagnostic errors, the chief complaints at the initial visit were frequently fever, abdominal pain, and vomiting. The common initial diagnoses included gastroenteritis, upper respiratory infection, and lower respiratory infection, whereas the final diagnoses were appendicitis, encephalitis\/encephalopathy, and intussusception. Diagnostic errors with poor outcomes frequently involved final diagnoses of encephalitis\/encephalopathy, myocarditis, and testicular torsion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Caution should be exercised to avoid diagnostic errors when addressing the chief complaints and initial diagnoses frequently identified in this study. Diseases listed as final diagnoses should be prioritized in the differential diagnoses. Addressing the factors contributing to diagnostic errors, along with increased awareness and targeted strategies for differential diagnosis, may reduce diagnostic errors and improve healthcare quality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ped.70183","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T12:25:53Z","timestamp":1756988753000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Nationwide questionnaire survey on diagnostic errors in pediatric outpatient acute care"],"prefix":"10.1111","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6473-0326","authenticated-orcid":false,"given":"Kenichi","family":"Tetsuhara","sequence":"first","affiliation":[{"name":"Subcommittee on Diagnostic Errors in Pediatric Outpatient Acute Care Committee on Pediatric Emergency and Intensive Care, Japanese Pediatric Society  Tokyo Japan"},{"name":"Department of Critical Care Medicine Fukuoka Children's Hospital  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8990-5265","authenticated-orcid":false,"given":"Hiromichi","family":"Hamada","sequence":"additional","affiliation":[{"name":"Subcommittee on Diagnostic Errors in Pediatric Outpatient Acute Care Committee on Pediatric Emergency and Intensive Care, Japanese Pediatric Society  Tokyo Japan"},{"name":"Department of Pediatrics, Graduate School of Medicine Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genya","family":"Taketazu","sequence":"additional","affiliation":[{"name":"Subcommittee on Diagnostic Errors in Pediatric Outpatient Acute Care Committee on Pediatric Emergency and Intensive Care, Japanese Pediatric Society  Tokyo Japan"},{"name":"Department of Pediatrics Asahikawa Kosei General Hospital  Asahikawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1207-8086","authenticated-orcid":false,"given":"Mitsuru","family":"Kashiwagi","sequence":"additional","affiliation":[{"name":"Subcommittee on Diagnostic Errors in Pediatric Outpatient Acute Care Committee on Pediatric Emergency and Intensive Care, Japanese Pediatric Society  Tokyo Japan"},{"name":"Department of Pediatrics Hirakata City Hospital  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Saito","sequence":"additional","affiliation":[{"name":"Subcommittee on Diagnostic Errors in Pediatric Outpatient Acute Care Committee on Pediatric Emergency and Intensive Care, Japanese Pediatric Society  Tokyo Japan"},{"name":"Department of Pediatrics Shirakawa Kosei General Hospital  Fukushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryugo","family":"Hiramoto","sequence":"additional","affiliation":[{"name":"Subcommittee on Diagnostic Errors in Pediatric Outpatient Acute Care Committee on Pediatric Emergency and Intensive Care, Japanese Pediatric Society  Tokyo Japan"},{"name":"Cantabile Pediatric Clinic  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Hamazaki","sequence":"additional","affiliation":[{"name":"Subcommittee on Diagnostic Errors in Pediatric Outpatient Acute Care Committee on Pediatric Emergency and Intensive Care, Japanese Pediatric Society  Tokyo Japan"},{"name":"Department of Pediatrics Osaka Metropolitan University Graduate School of Medicine  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Takeshima","sequence":"additional","affiliation":[{"name":"Subcommittee on Diagnostic Errors in Pediatric Outpatient Acute Care Committee on Pediatric Emergency and Intensive Care, Japanese Pediatric Society  Tokyo Japan"},{"name":"Department of Pediatrics Hyogo Medical University  Nishinomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Improving diagnosis in health care","author":"Committee on Diagnostic Error in Health Care, Board on Health Care Services, Institute of Medicine, The National Academies of Sciences, Engineering, and Medicine","year":"2015"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.13.1493"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-0496"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcl.2018.07.003"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-045948D"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-016-2772-0"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1515\/dx-2015-0033"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2009-3218"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzu066"},{"key":"e_1_2_9_11_1","first-page":"84","article-title":"Questionnaire survey on diagnostic errors in pediatric outpatient acute care","volume":"129","author":"Tetsuhara K","year":"2025","journal-title":"J Jpn Pediatr Soc"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2022-002062"},{"key":"e_1_2_9_13_1","unstructured":"Ministry of Health Labour and Welfare.Physician dentist and pharmacist statistics 2022. (in Japanese). [cited 2025 Jan 29]. Available from:https:\/\/www.e\u2010stat.go.jp\/stat\u2010search\/files?page=1&layout=datalist&toukei=00450026&tstat=000001135683&cycle=7&tclass1=000001215100&tclass2=000001215103&stat_infid=000040155806&tclass3val=0. (in Japanese)"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2012.244"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2023.04.006"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005972"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12144"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-1594"},{"key":"e_1_2_9_19_1","article-title":"Misdiagnosis of acute appendicitis cases in the emergency room","volume":"16","author":"Mostafa R","year":"2024","journal-title":"Cureus"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.22248"},{"key":"e_1_2_9_21_1","unstructured":"Japanese Society of Child Neurology.Guidelines for the Diagnosis and Treatment of Acute Encephalopathy in Childhood 2023. [cited 2025 Jan 21]. Available from:https:\/\/www.childneuro.jp\/about\/6443\/"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2023.6672"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-1073"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-017-1638-1"},{"key":"e_1_2_9_25_1","first-page":"e123","article-title":"Diagnosis and management of myocarditis in children: a scientific statement from the American Heart Association","volume":"10","author":"Law YM","year":"2021","journal-title":"Circulation"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2022-015314"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-3949"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.162.10.969"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(12)70361-3"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000003227"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000002943"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.736018"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1177\/0009922816687325"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-0815"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/ped.15162"},{"key":"e_1_2_9_36_1","unstructured":"The 27th annual nationwide survey on Kawasaki disease. Kawasaki Disease National Surveillance Group (in Japanese) [cited 2025 Jan 29]. Available from:https:\/\/www.jichi.ac.jp\/dph\/wp\u2010dph\/wp\u2010content\/uploads\/2023\/09\/3aed51a15e14397c8ba83d470df0226f.pdf"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2017.03.002"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/ams2.977"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1515\/dx-2023-0019"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1515\/dx-2020-0023"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.0196"},{"key":"e_1_2_9_42_1","unstructured":"Japanese Society for Inherited Metabolic Diseases.Clinical practice guidelines for neonatal mass screening target diseases 2019. (in Japanese) [cited 2025 Jan 29]. Available from:https:\/\/jsimd.net\/pdf\/newborn\u2010mass\u2010screening\u2010disease\u2010practice\u2010guideline2019.pdf"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1159\/000506236"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2017.03.037"}],"container-title":["Pediatrics International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ped.70183","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ped.70183","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ped.70183","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:47:01Z","timestamp":1790912821000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ped.70183"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":43,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1111\/ped.70183"],"URL":"https:\/\/doi.org\/10.1111\/ped.70183","archive":["Portico"],"relation":{},"ISSN":["1328-8067","1442-200X"],"issn-type":[{"value":"1328-8067","type":"print"},{"value":"1442-200X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2025-02-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70183"}}