According to a recent report by The Independent, a young girl in the UK who experienced red flags for meningitis and sepsis, such as high fever, fast heart rate, leg pain, drowsiness, and vomiting, had her condition misdiagnosed by the hospital's emergency department. She was discharged, only to return a few hours later and receive a proper diagnosis. The delay in treatment led to her developing multiple organ failure, ultimately resulting in the amputation of both legs above the knee and both arms above the elbow. The Frimley Health NHS Foundation Trust took responsibility for the misdiagnosis, leading to a £39 million ($48 million) settlement for the young girl. Sepsis is a commonly misdiagnosed condition in emergency rooms, resulting in up to 250,000 deaths annually, according to a new study. The US Department of Health and Human Services' Agency for Healthcare Research and Quality revealed that out of 130 million yearly hospital emergency department visits in the United States, approximately 7.4 million people receive inaccurate diagnoses, and around 370,000 of those may experience severe harm as a result.
1) Causes of Misdiagnosis by Medical Professionals
According to a recent study entitled "Diagnostic Errors in the Emergency Department: A Systematic Review," conducted by researchers at Johns Hopkins University, approximately one in 18 emergency patients receive an incorrect diagnosis, with one in 50 experiencing an adverse event, and one in 350 suffering permanent disability or death. The primary reason for misdiagnosis, as per the study, is due to the presence of nonspecific, mild, transient, or atypical symptoms that could correspond to various illnesses. The study explains that "nonspecific or atypical symptoms increase the likelihood of error" for a specific disease, citing the example of stroke, where dizziness or vertigo raises the odds of misdiagnosis 14 times higher than motor symptoms, with initial misdiagnoses of dizziness and vertigo occurring 40% of the time. "This is the elephant in the room no one is paying attention to," states Dr. David E. Newman-Toker, a neurologist at Johns Hopkins University and director of its Armstrong Institute Center for Diagnostic Excellence and one of the study's authors.
2) Frequently Misdiagnosed Ailments: A List of Five
A recent study shows that five ailments, listed in decreasing order, account for 39% of the severe harm caused by misdiagnoses. These conditions include stroke, myocardial infarction (heart attack), aortic aneurysm or dissection, spinal cord compression or injury, and venous thromboembolism (blood clot in a vein). Approximately 17% of all strokes are misdiagnosed by physicians. Additionally, the top 15 misdiagnosed conditions are responsible for 68% of cases of serious harm.
3) Assessing the Scale of the Hazard
A new study reveals that out of the 130 million emergency department visits in the US each year, approximately 7.4 million patients, or 5.7%, are misdiagnosed. This misdiagnosis leads to about 2.6 million patients, or 2%, experiencing an adverse event, while around 370,000 patients, or 0.3%, suffer serious harm due to diagnostic error. The study estimates that a typical emergency department, which reports around 25,000 visits annually, would experience around 1,400 diagnostic errors, 500 diagnostic adverse events, and 75 serious cases of harm, including 50 fatalities, at the rate reported by the study.
4) Which Group Suffers the Greatest Impact
According to the study, there is often a significant increase in the risk of misdiagnosis associated with female gender and non-white race, ranging from 20% to 30%. While these disparities were not always consistent across studies, researchers discovered that being a woman or a racial/ethnic minority does not appear to be protective against misdiagnosis and may, at best, be considered neutral.
5) Possible Solutions to the Issue at Hand
According to the study, the wide range of diagnostic error rates across various diseases, symptoms, and hospitals highlights the possibility of improvement. The study also indicates that more than two-thirds of the cases of severe harm are due to just 15 diseases, which are linked to cognitive errors, mainly in cases with atypical symptoms. To improve the accurate diagnosis of these diseases, scalable solutions should focus on the most commonly misdiagnosed clinical presentations. The study recommends changing specific policies, such as standardizing measurement and research reporting, creating a National Diagnostic Performance Dashboard to monitor performance, and leveraging research funding, public accountability, and payment reforms to speed up the development and deployment of solutions to address the issue.