A recent government study reports that around 250,000 Americans die each year due to misdiagnoses from care administered in emergency departments (EDs).
The findings of the study spurred an immediate response from the President of the American College of Emergency Physicians (ACEP), Dr. Christopher S. Kang, who said in an interview with the New York Times that “in addition to making misleading, incomplete and erroneous conclusions from the literature reviewed, the report conveys a tone that inaccurately characterizes and unnecessarily disparages the practice of emergency medicine in the United States.”
David Newman-Toker, M.D., Ph.D., a neurologist at Johns Hopkins University, and co-author of the study, defends the methodology and maintains that while there are significant errors being made in emergency rooms, the key to changing this would be to make advancements that could help doctors to avoid them rather than “laying the blame on the feet of the emergency room physicians.”[1]
The study, a systemic review from the Agency for Healthcare Research and Quality through its Evidence-Based Practice Centers states that among 130 million ED visits in the U.S. per year, 7.4 million patients are misdiagnosed. In addition, 2.6 million suffer an adverse event, and about 370,000 suffer serious harm from those diagnostic errors. This is roughly “1 in 18 patients receiving an incorrect diagnosis, 1 in 50 suffering an adverse event, and 1 in 350 suffering permanent disability or death.” The “good news,” Dr. Manuel Gonzalez-Brito, the Chief Medical Director at MSP Recovery notes, is that “emergency departments have a correct diagnosis (and presumed subsequent care) of nearly 95% of cases.” While there is still a 5% chance of misdiagnosis, “this is encouraging,” ensures Dr. Gonzalez-Brito, noting that “diagnostic accuracy in the emergency department is high.”
The most common conditions that are being associated with misdiagnosis are stroke, myocardial infarction, aneurysm and dissection, spinal cord compression and injury and venous thromboembolism, which account for 68% of all misdiagnosed conditions. These are followed by the less common sepsis, lung cancer, traumatic brain injury and traumatic intracranial hemorrhage, arterial thromboembolism, spinal and intracranial abscess, cardiac arrhythmia, pneumonia, gastrointestinal perforation and rupture, and intestinal obstruction.
Researchers looked at studies of ED performance from 2000-2021, but much of the data were collected from EDs in Canada, Spain, and Switzerland, which could be applied to the U.S., and could be looked at in one of two ways. Essentially, the data not being from the U.S. means that actual U.S. data “could be better (or worse),” Dr. Gonzalez-Brito states, reiterating that it is hard to tell from the results of this particular study.
The study found that ultimately the “root cause of ED diagnostic errors were mostly cognitive errors linked to the process of bedside diagnosis.” Dr. Gonzalez-Brito agrees, noting that the mistakes made were “mostly errors in clinical decision making or judgment.”
While the results of the study would suggest that there is a large issue present in the United States emergency departments that is leading to an immense number of misdiagnoses, many leading to adverse effects and additional injury, the study has not yet been completed based on ED data from the U.S. By extrapolating data from EDs in countries that are statistically similar to the U.S., there are some important considerations to be taken into account, while it is still important to note that the information is not directly related as the data is not from U.S. EDs.
Medical misdiagnosis has been shown to be a prevalent issue worldwide in emergency departments, and the results of this study can aid in both shedding light on that issue, as well as helping to create solutions to the errors prevalent in this line of work causing many of these misdiagnoses.
