Diagnostic errors in emergency departments (EDs) are a major patient safety concern and can cause serious harm or even death. A study was done to find out which diseases and clinical presentations are most often linked to diagnostic errors in EDs in the United States and other developed countries.
The study also tried to find out how often errors and harm happen and what causes them. The study looked at 279 studies with 19,127 citations.
The 15 most common conditions linked to serious misdiagnosis-related harm (accounting for 68% of serious harm cases) were stroke, heart attack, aortic aneurysm and dissection, spinal cord injury, blood clots, meningitis and encephalitis, sepsis, lung cancer, brain injury and bleeding in the brain, blood clots in arteries, abscesses in the spine and brain, irregular heartbeats, pneumonia, holes in the stomach or intestine, and blocked intestine.
The rate of errors for each disease ranged from 1.5% for heart attacks to 56% for abscesses in the spine. There was also a lot of variation in error rates between hospitals. It is estimated that 5.7% of ED visits had at least one diagnostic error, with 2.0% of visits resulting in preventable harm, 0.3% resulting in serious harm, and 0.2% resulting in deaths.
When these rates are extrapolated to all ED visits in the United States (an estimated 130 million visits per year), this would mean there are 7.4 million diagnostic errors, 2.6 million preventable harm events, and 371,000 serious harm events each year, including over 100,000 permanent, severe disabilities and 250,000 deaths.
Most diagnostic error malpractice cases (89%) involved problems with decision-making or judgment, with key process failures being errors in diagnostic assessment, test ordering, and test interpretation.
The main problems were with how diagnoses were made, how tests were ordered, and how test results were interpreted.
These failures were often attributed to inadequate knowledge, skills, or reasoning, particularly in cases with atypical or subtle presentations.
The study had some limitations, including the use of malpractice cases and incident reports to find out which diseases cause serious harm, the use of only a small number of studies for overall error and harm rates, and the lack of consistency in how errors and harm were defined and measured across studies.