Objectives. To assess the frequency of different types of diagnostic errors in patients with central nervous system (CNS) infection\nfrom the onset of symptoms to admission to the hospital, where the correct diagnosis was made. Methods. A cross-sectional\nobservational design was used, and the information was collected by interviewing patients and/or their knowledgeable relatives\nas well as reviewing the accompanying medical record documents and hospital records. Results. Of 169 adult patients with CNS\ninfection, 129 (76.33%) were subject to diagnostic errors. Failure in ordering tests and hypothesis generation were the most\ncommon types of diagnostic errors that accounted for more than 70% of errors. Several contributing factors that were associated\nwith incorrect diagnostic hypotheses included failure in taking a patientâ??s comprehensive history such as detecting relevant\nepidemiological clues, conducting a full clinical examination, and interpreting diagnostic evidence.The relationship between poor\nclinical outcome and longer delay from the onset of illness to diagnosis, inappropriate empirical antibiotic therapy, and lower level\nof consciousness on admission were found to be statistically significant. Conclusions. Although diagnosis and management of CNS\ninfection in some patients are straightforward, clinical decision making in facing patients with complex scenarios often requires\nclinical reasoning instead of relying only on intuitive diagnosis. Justification in requesting diagnostic measures and interpretation\nof their results based on clinical findings and patient information could be a critical factor in preventing a substantial number of\ndiagnostic errors in patients with CNS infection.
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