Diagnostic accuracy high in emergency departments

Diagnostic accuracy is high in the emergency department, with about 5.7 percent of patients misdiagnosed, according to a report published Dec. 15 by the Agency for Healthcare Research and Quality.

David E. Newman-Toker, M.D., Ph.D., from the Johns Hopkins University Evidence-based Practice Center in Baltimore, and colleagues examined diagnostic errors or misdiagnosis-related harms in emergency departments in the United States or other developed countries. A total of 279 studies that addressed three key questions were included.

According to the report, in the United States, diagnostic accuracy is high in the emergency department overall, but about 5.7 percent of patients receive an incorrect diagnosis. As a result of this incorrect diagnosis, some suffer an adverse event (about 2.0 percent) and some of these adverse events are serious (about 0.3 percent). These rates are equivalent to those in primary care and hospital inpatient care. Overall, five conditions account for 39 percent of serious misdiagnosis-related harms (stroke, myocardial infarction, aortic aneurysm/dissection, spinal cord compression/injury, and venous thromboembolism), while the top 15 conditions accounted for 68 percent. Considerable variation is seen in diagnostic error rates by disease, ranging from 1.5 percent for myocardial infarction to 56 percent for spinal abscess. For a given disease, the likelihood of error is increased with nonspecific or atypical symptoms. Dizziness or vertigo increases the odds of misdiagnosis 14-fold over motor symptoms for stroke.

“Scalable solutions to enhance bedside diagnostic processes are needed, and these should target the most commonly misdiagnosed clinical presentations of key diseases causing serious harms,” the authors write.

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