Missed Opportunities to Dx CV Events in ED

Robert Bell rmsbell200 at YAHOO.COM
Sat Mar 3 21:48:33 UTC 2018

 And how often is takotsubo cardiomyopathy missed? That presents like an MI but in most cases gets better with time (weeks).
Rob Bell, MD
   On Saturday, March 3, 2018, 12:50:49 PM MST, Ruth Ryan <ruth at RYAN-GRAHAM.COM> wrote: 
Hello all,
Here is a link to an interesting article citing the IOM/NAM report on dx error. It’s a study of unrecognized CV events. The corresponding author Waxman is with the RAND Corp.
Waxman DA, Kanzaria HK, Schriger DL. Unrecognized Cardiovascular Emergencies Among Medicare Patients. JAMA Intern Med. Published online February 26, 2018. doi:10.1001/jamainternmed.2017.8628
They found the rate of missed events ranged from 2.3% - 4.5%.
While the authors conclude these numbers may not be improved upon:
“Among Medicare patients, opportunities to diagnose
ruptured AAA, AMI, stroke, aortic dissection, and SAH are missed in less than 1 in 20 ED
presentations. Further improvement may prove difficult.” (my emphasis)
…they nevertheless identify a number of factors—the usual suspects, including female gender—associated with missed diagnoses:
“Patient characteristics associated with unrecognized emergencies included age younger than 65 years, dual eligibility for Medicare
and Medicaid coverage, female sex, and each of the following chronic conditions: end-stage renal disease, dementia, depression,
diabetes, cerebrovascular disease, hypertension, coronary artery disease, and chronic obstructive pulmonary disease.”
Ruth Ryan

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