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Almost 6% of patients misdiagnosed in the emergency department

by John R. Fischer, Senior Reporter | December 21, 2022
Cardiology Emergency Medicine Risk Management Stroke
Nearly 6% of ER patients are misdiagnosed each year.
Nearly 6% of patients in emergency departments across the U.S. receive the wrong diagnosis each year, resulting in an estimated 7.4 million misdiagnoses.

An estimated 130 million people are seen annually in EDs, with 2.6 million receiving harm that could have been prevented and 370,000 dying or becoming permanently disabled from misdiagnosis, reported the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality.

Nonspecific or atypical symptoms contributed most to misdiagnosis. The root causes for ED diagnostic errors were mainly cognitive mistakes linked to the bedside diagnosis process. Individual case factors also increased cognitive challenges for identifying conditions.

“This translates to about one in 18 ED patients receiving an incorrect diagnosis, one in 50 suffering an adverse event, and one in 350 suffering permanent disability or death. These rates are comparable to those seen in primary care and hospital inpatient care,” wrote the authors in their study.

Reviewing 300 studies from between January 2000 and September 2021, the agency found that about 1,400 diagnosis errors occur every year in each ER. Additionally, each experiences 500 diagnostic adverse events and 75 serious harms, including 50 deaths per ED.

The conditions misdiagnosed the most are stroke, myocardial infarction, aortic aneurysm/dissection, spinal cord compression/injury, and venous thromboembolism. Together, they account for 39% of all serious misdiagnosis-related harms.

Stroke, for example, was missed 17% of the time due to people reporting symptoms of dizziness and vertigo. Among these patients, 40% had their stroke initially missed.

Women and people of color were at a 20% to 30% higher risk of being misdiagnosed.

And variation in diagnostic error rates among specific hospital EDs is wide, as are methods for measuring them, say the authors. They recommend scalable solutions for improving bedside diagnostic processes and for ER studies to focus on evidence gaps, such as errors in common diseases with lower-severity harm, pediatric ED errors, overcrowding and false positives.

Additionally, policy changes should be made to standardize research reporting, create a national diagnostic performance dashboard, and establish multiple policy levers for rapid deployment of solutions to address patient safety concerns.

“Not all diagnostic errors or harms are preventable, but wide variability in diagnostic error rates across diseases, symptoms, and hospitals suggests improvement is possible,” wrote the authors.

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