Quantifying ER misdiagnoses

Mark Graber Mark.Graber at IMPROVEDIAGNOSIS.ORG
Sun Jul 23 23:36:11 UTC 2017


Gina – I’m not aware of data on that exact question, but there are a few published studies that might be relevant:

Obermeyer 2017 – Looked at early death after an ER visit:  Leading causes were cardiovascular disease and MI, COPD, and narcotic overdose.
Medford-Davis et al 2016 – In patients with abdominal pain, biliary problems and UTI’s were the most commonly missed problems

Mark L Graber MD FACP
President, SIDM
[cid:image001.png at 01D303EA.EEC513C0]

From: Karen Cosby <kcosby40 at GMAIL.COM>
Reply-To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Karen Cosby <kcosby40 at GMAIL.COM>
Date: Sunday, July 23, 2017 at 6:35 PM
To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] Quantifying ER misdiagnoses

The problem is that we don't have a value for  "n", the number of all such diagnoses, rather just reports of recognized misses. We often assume they are among the most common mis-diagnoses in Emergency Medicine when in fact they are probably just the missed diagnoses that are most consequential, and thus most likely to be noticed. Since many conditions can have differing presentations, it is difficult to ever establish the denominator-- the incidence of all cases. Some diagnoses are probably more commonly missed but have less impact on outcome. By default we focus on the those cases that result in poor (and potentially preventable) outcome.

Sent from my iPhone

On Jul 23, 2017, at 4:44 PM, Pat Croskerry <croskerry at EASTLINK.CA<mailto:croskerry at EASTLINK.CA>> wrote:
Gina: I don’t know of any demographic studies in the ED that have ranked diagnoses in terms of their failure rate, although a recall some data from an unpublished study in which respiratory, cardiac and missed injuries diagnoses were ranked as the most likely – in that order.
The psychologists Hogarth specifically described the emergency department as a ‘wicked environment’ – the implication being that the work conditions and ambient conditions generally were not supportive of good decision making.
The most recent study on ED diagnostic errors that I am aware of is that by Okafor N, Payne VL, Chathampally Y, et al. Using voluntary reports from physicians to learn from diagnostic errors in emergency medicine. Emerg Med J 2016;33:245–52.
Pat Croskerry

From: Gina Siddiqui [mailto:gina.siddiqui at GMAIL.COM]
Sent: July 23, 2017 5:06 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [IMPROVEDX] Quantifying ER misdiagnoses

Hi all,

Wanted to ask the group's knowledge on studies that have ranked diagnoses in the ER by the likelihood they are missed/mistaken for something else -- an empirical/quantitative measure of the "noise" attribute of certain diagnoses that Dr. Croskerry refers to.

I'm especially interested in estimates for the prevalence of diagnostic error in PE, ectopic pregnancy, CVA, and SAH.

Gina

Gina M. Siddiqui, MD
Yale New Haven Hospital
Mobile: 703-973-3470
Twitter: @gina_wrote<https://twitter.com/Gina_wrote>



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