Missed Opportunities to Dx CV Events in ED

Tom Benzoni benzonit at GMAIL.COM
Sat Mar 3 22:15:31 UTC 2018


How would this look as a Venn diagram?
tom

On Sat, Mar 3, 2018 at 3:48 PM, Robert Bell <
0000000296e45ec4-dmarc-request at list.improvediagnosis.org> wrote:

> 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
>
> https://jamanetwork.com/journals/jamainternalmedicine/
> fullarticle/2673300?utm_source=silverchair&utm_campaign=jama_network&utm_
> content=weekly_highlights&cmp=1&utm_medium=email
>
>
>
> 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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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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