MISDIAGNOSIS IN DEMENTIA - COMPARISONS OF DIAGNOSTIC ERROR RATE AND RANGE OF HOSPITAL INVESTIGATION ACCORDING TO MEDICAL SPECIALITY

Clinical diagnosis was reassessed via case note audit in 146 (73%) patients with a main diagnosis of dementia randomly selected from computer-linked general and psychiatric hospital morbidity records of dementia patients admitted to Scottish hospitals in the Lothian region between 1968 and 1987. Twenty-three cases (16%) failed to meet DSM-III-R criteria on case note review. There was no significant difference in the case ascertainment rate of psychiatrists, physicians and geriatricians. Cerebrovascular accidents, depression and acute confusional states were the main differential diagnoses in failed cases (75%). The range and cost of hospital investigation in dementia was noted and varied according to specialty with significant differences between specialties in the use of specific tests, secondary investigations and postmortem examination. Diagnostic error rate and use of secondary investigations were contrasted for the periods 1968-84 and 1985-87, but there was no evidence of significant change.