Diagnostic Errors in Sepsis: A Systematic Review of the Literature
5 affiliations
- 1Department of Cardiology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe CW1 4QJ, UK
- 2Department of General Surgery, Jersey General Hospital, Jersey JE1 3QS, UK
- 3Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK
- 4Cardiovascular Clinical Research Facility, University of Oxford, Oxford OX3 9DU, UK
- 5Mid Cheshire Hospitals NHS Foundation Trust, Crewe CW1 4QJ, UK
Abstract
Background/Objectives: Sepsis is a major cause of hospitalization and mortality which may be prevented with early diagnosis. This systematic review aims to evaluate the literature on diagnostic errors in sepsis. Methods: We conducted a systematic review to evaluate the rate and outcomes of diagnostic errors in sepsis. We searched MEDLINE and EMBASE in September 2026 for studies that evaluated diagnostic errors in sepsis. Data were extracted into tables and narratively synthesized. Results: Twenty-six studies involving 868,057 patients diagnosed with sepsis were included. Definitions of diagnostic error varied and included misdiagnosis, missed diagnosis, delayed diagnosis, failure of recognition systems, and overdiagnosis. Among adults, reported rates of diagnostic error ranged from 0.6% to 86.2%, depending on the definition used. Misdiagnosis of infection source occurred in 11.6% of patients, sepsis misdiagnosis rates ranged from 8.3% to 25.3% in most cohorts, and delayed recognition ranged from 20.0% to 72.9%. In pediatric studies, missed or delayed sepsis occurred in 2.9% to 16.9% of patients. Diagnostic error was associated with delayed antibiotic administration, increased illness severity, longer hospitalization, and higher intensive care utilization. However, findings regarding mortality were inconsistent, with several studies reporting no significant association after adjustment. In children, missed sepsis was associated with increased risk of intensive care admission, but no difference in mortality. Conclusions: Diagnostic error in sepsis is common and variably defined across studies. Evidence linking diagnostic error to mortality and intensive care admission is inconsistent; however, diagnostic error is frequently associated with delayed treatment.
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BibTeX
@article{kwok2026diagnostic,
title = {{Diagnostic Errors in Sepsis: A Systematic Review of the Literature}},
author = {Chun Shing Kwok and Soyoung Lee and Azreen Afzal and Sadie Bennett and Jaime Halvorsen and Clare Hammell},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208152},
url = {https://www.mdpi.com/2077-0383/15/20/8152},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Diagnostic Errors in Sepsis: A Systematic Review of the Literature
AU - Chun Shing Kwok
AU - Soyoung Lee
AU - Azreen Afzal
AU - Sadie Bennett
AU - Jaime Halvorsen
AU - Clare Hammell
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208152
UR - https://www.mdpi.com/2077-0383/15/20/8152
AB - Background/Objectives: Sepsis is a major cause of hospitalization and mortality which may be prevented with early diagnosis. This systematic review aims to evaluate the literature on diagnostic errors in sepsis. Methods: We conducted a systematic review to evaluate the rate and outcomes of diagnostic errors in sepsis. We searched MEDLINE and EMBASE in September 2026 for studies that evaluated diagnostic errors in sepsis. Data were extracted into tables and narratively synthesized. Results: Twenty-six studies involving 868,057 patients diagnosed with sepsis were included. Definitions of diagnostic error varied and included misdiagnosis, missed diagnosis, delayed diagnosis, failure of recognition systems, and overdiagnosis. Among adults, reported rates of diagnostic error ranged from 0.6% to 86.2%, depending on the definition used. Misdiagnosis of infection source occurred in 11.6% of patients, sepsis misdiagnosis rates ranged from 8.3% to 25.3% in most cohorts, and delayed recognition ranged from 20.0% to 72.9%. In pediatric studies, missed or delayed sepsis occurred in 2.9% to 16.9% of patients. Diagnostic error was associated with delayed antibiotic administration, increased illness severity, longer hospitalization, and higher intensive care utilization. However, findings regarding mortality were inconsistent, with several studies reporting no significant association after adjustment. In children, missed sepsis was associated with increased risk of intensive care admission, but no difference in mortality. Conclusions: Diagnostic error in sepsis is common and variably defined across studies. Evidence linking diagnostic error to mortality and intensive care admission is inconsistent; however, diagnostic error is frequently associated with delayed treatment.
SN - 2077-0383
ER -