AW: Undesirable diagnostic events

Kodolitsch von, Yskert kodolitsch at UKE.DE
Wed Jan 31 17:33:00 UTC 2018


Hi Mark,

Thank you for keeping us updated, all the time.

I am not sure, if some of our recent work is of interest for the “improve-DX”-community.
See at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582058/

But we referred to your work on diagnostic error in a study that was not primarily directed at the subject of diagnostic error:
We assessed the diagnostic accuracy of transthoracic echocardiography (TTE) for bicuspid aortic valve disease (BAV).
BAV carries a significant burden of morbidity already in middle-aged persons because of the need for aortic valve operations, or even more seriously, for highly lethal aortic dissection.
The prevalence of BAV in 1-2% in the general population, and TTE is the almost exclusive diagnostic tool for screening and diagnosing BAV.

The classical studies of TTE-accuracy for BAV reach up to 100%. However, these classical studies were performed with optimal patients, expert examiners, and study conditions.
In contrast, we identified <50% sensitivity (!) of TTE for BAV under clinical routine conditions.

I think, that inquiring more intensively into the conditions of routine settings may lead us to some important insights on factors that explain why clinicians are or may be unable to exploit the full diagnostic potential of diagnostic modalities.
We discussed (only as options, since the study was retrospective) that beside the framing of the diagnostic question, there may be issues like training, supervision, time constraints and so on.

I am not sure, if these data and remarks may be useful for other colleagues in our improve-DX community. I admit, that only during the review-process of our study, the link between routine conditions and sources of diagnostic error occurred to me. This is some irony, because I read the communications on “improve _DX” of a couple of years already.

Best regards from Hamburg

Yskert


Von: Mark Graber [mailto:Mark.Graber at IMPROVEDIAGNOSIS.ORG]
Gesendet: Mittwoch, 31. Januar 2018 17:17
An: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Betreff: [IMPROVEDX] Undesirable diagnostic events

From the Shameless Commerce Division:  Congratulations to Andrew Olson (Hardeep Singh and I were co-authors) for leading the effort to describe a new approach to finding and studying diagnostic errors, by identifying ‘undesirable diagnostic events’.  Using this UDE concept provides a pragmatic way to begin measuring key aspects of diagnostic performance.

The reference can be found here:   http://rdcu.be/FRAX<http://em.rdcu.be/wf/click?upn=KP7O1RED-2BlD0F9LDqGVeSESnrWGmmkOoHud4oZ-2BXMF0-3D_cmh4GCf3-2FkJv52LHejifFGodRdgySUk-2BNZhr8EkQ5uB-2FoyKeEinaKb1nL28Rdd00YuOLEA1UIf-2FsOqmBSoAkZaidwfcA2tCJM7wULn178O0-2B7UBmbr7ZCXGywBn3ZqmjImpQQQCmhHYaS3HK0URdJvR5AS3okYUyAIOWm69Nb6WYVD7yn3SnpIOfvbfgYkSjcKmMYlc-2FvCRE87rjNrzvXyYMfDP27Lnnf0hM0UrwIiLeLgh8hL9eiTidU-2FOgjTM4QMRYIKtEjzSO0gJ-2FCJhj0A-3D-3D>


Mark L Graber MD FACP
President, SIDM
Senior Fellow, RTI International
Professor Emeritus, Stony Brook University
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