Good news and bad: The CHARMED trial of second opinions in the ED

Mark Graber Mark.Graber at IMPROVEDIAGNOSIS.ORG
Tue Apr 24 14:12:38 UTC 2018


The just-published results of the French CHARMED trial<https://www.medpagetoday.com/emergencymedicine/emergencymedicine/72493?xid=nl_mpt_DHE_2018-04-24&eun=g984329d0r&pos=1&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202018-04-24&utm_term=Daily%20Headlines%20-%20Active%20User%20-%20180%20days> found that having a second ER physician ‘cross check’ the diagnosis and plans for ER patients reduced adverse events by 40% (10.7 vs 6.4%) and near misses (5.8 vs 3.1%) by a comparable 47%.  The good news is that the intervention seemed to work.  The bad news is that while the near miss reduction was statistically significant in this trial of 1680 patients, the adverse event reduction was not.  This demonstrates how difficult it will be to study true outcomes in diagnostic error reduction, even in settings where the incidence is fairly large (the authors cite an ED error rate of 10% as being the norm).

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