Systematic review: About one in 18 patients are misdiagnosed in ED - Healio

Approximately 7.4 cardinal patients are misdiagnosed successful EDs each year, according to a study from the HHS’ Agency for Healthcare Research and Quality.

“Diagnostic errors are a known diligent information interest crossed each objective settings, including the ED,” David E. Newman-Toker, MD, PhD, manager of the Armstrong Institute Center for Diagnostic Excellence astatine Johns Hopkins and president-elect of the Society to Improve Diagnosis successful Medicine, and colleagues wrote. “We conducted a systematic reappraisal to find the astir predominant diseases and objective presentations associated with diagnostic errors (and resulting harms) successful the ED, measurement mistake and harm frequency, arsenic good arsenic measure causal factors.”

Data derived from: Newman-Toker DE, et al. Diagnostic errors successful the exigency department: A systematic review. 2022;doi:10.23970/AHRQEPCCER258.

The researchers searched Embase, PubMed and Cumulative Index to Nursing and Allied Health Literature from January 2000 done September 2021. They included targeted grey lit and probe studies that reported misdiagnosis and related harms successful EDs successful the U.S. “or different developed countries with ED attraction deemed comparable,” they wrote.

Newman-Toker and colleagues past applied modular definitions for diagnostic errors, adverse events and superior harms similar imperishable disablement oregon death, noting that “preventability was determined by archetypal survey authors oregon differences successful harms crossed groups.”

Overall, the researchers identified 19,127 citations and included 279 studies successful the systematic review.

Among 130 cardinal ED visits successful the U.S., 5.7% (95% CI, 4.4-7.1) of patients were misdiagnosed and 2% (95% CI, 1-3.6) — oregon 2.6 cardinal radical — suffered an adverse lawsuit arsenic a result, the researchers found. Further, 0.3% — oregon 370,000 radical — suffered perchance preventable imperishable disablement oregon death.

“This translates to astir 1 successful 18 ED patients receiving an incorrect diagnosis, 1 successful 50 suffering an adverse event, and 1 successful 350 suffering imperishable disablement oregon death,” Newman-Toker and colleagues wrote. “Put successful presumption of an mean ED with 25,000 visits annually and mean diagnostic performance, each twelvemonth this would beryllium implicit 1,400 diagnostic errors, 500 diagnostic adverse events and 75 superior harms, including 50 deaths per ED.”

Notably, “female enactment and non-white contention were often associated with important (20–30%) increases successful misdiagnosis risk,” the researchers wrote.

About 68% of superior harms were attributable to conscionable 15 diseases and were “linked to cognitive errors, peculiarly successful cases with ‘atypical’ manifestations,” according to Newman-Toker and colleagues.

The apical 5 conditions that were astir commonly misdiagnosed — accounting for 39% of superior misdiagnosis-related harms — were:

• stroke;
• myocardial infarction;
• aortic aneurysm/dissection;
• spinal cord compression/injury; and
• venous thromboembolism.

The mean disease-specific mistake rates, the researchers reported, varied from 1.5% (MI) to 56% (spinal abscess), “with further saltation by objective presentation.” For example, the missed mean was 17% for changeable but 4% for weakness and 40% for dizziness and vertigo. Additionally, determination was saltation by hospital; successful 1 study, missed MI ranged from 0% to 29%.

“Although errors were often multifactorial, 89% of diagnostic mistake malpractice claims progressive failures of objective decision-making oregon judgment, careless of the underlying illness present,” the researchers wrote. “Key process failures were errors successful diagnostic assessment, trial ordering, and trial interpretation. Most often these were attributed to inadequate knowledge, skills, oregon reasoning, peculiarly successful ‘atypical’ oregon different subtle lawsuit presentations.”

Policy changes that should beryllium considered successful airy of this review, according to the researchers, include:

• maximizing comparability of measures of misdiagnosis-related harms and diagnostic errors by standardizing measurement and probe results reporting;
• tracking show with a National Diagnostic Performance Dashboard; and
• facilitating the accelerated improvement and implementation of solutions “to code this critically important diligent information concern” by utilizing aggregate argumentation levers similar probe funding, nationalist accountability and outgo reforms.

“Although estimated ED mistake rates are debased ... the fig of patients perchance impacted is large. Not each diagnostic errors oregon harms are preventable, but wide variability successful diagnostic mistake rates crossed diseases, symptoms, and hospitals suggests betterment is possible,” the researchers concluded. “Scalable solutions to heighten bedside diagnostic processes are needed, and these should people the astir commonly misdiagnosed objective presentations of cardinal diseases causing superior harms.”