Over 7 million misdiagnoses made in emergency rooms each year, study finds

Abigail Adcox

December 18, 05:00 AM December 18, 05:00 AM

Approximately 1 in 18 patients visiting the emergency room receives an incorrect diagnosis, a new analysis finds.

An estimated 7.4 million misdiagnoses are made each year, with 2.5 million suffering an adverse event as a result of the error, according to a report published by the Department of Health and Human Services' Agency for Healthcare Research and Quality.

The American College of Emergency Physicians and other emergency medicine organizations have pushed back on the report, arguing that the data are flawed and do not take into account the differences in emergency medicine from other clinical settings.

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"Although estimated ED error rates are low (and comparable to those found in other clinical settings), the number of patients potentially impacted is large. Not all diagnostic errors or harms are preventable, but wide variability in diagnostic error rates across diseases, symptoms, and hospitals suggests improvement is possible," the researchers wrote.

On average, an emergency department with 25,000 visits annually makes approximately 1,400 misdiagnoses.

The top five conditions that were misdiagnosed were stroke, myocardial infarction, aortic aneurysm/dissection, spinal cord compression/injury, and venous thromboembolism.

Stroke is misdiagnosed roughly 17% of the time, with the odds increasing among patients who reported symptoms of dizziness and vertigo. An estimated 40% of patients who had those two symptoms had their stroke diagnosis missed.

The strongest factor in misdiagnoses occurred in patients whose symptoms were atypical, nonspecific, or mild for the underlying illness. In about 90% of cases in which the misdiagnosis resulted in serious harm to the patient, there was a malpractice claim.

The report noted that the level of misdiagnoses in emergency rooms was similar to the amount seen at primary care physicians, hospital inpatients, and other clinical settings and that overall diagnostic accuracy was high.

The American College of Emergency Physicians, the American Academy of Emergency Medicine, and other emergency medicine organizations called the findings of the report "faulty."

"The repercussions of this faulty report cannot be overstated, as it will irresponsibly and falsely alarm the public and potentially lead them to delay or even forego treatment for time-sensitive emergencies, while also undermining the relationship between patient and emergency physician," the organizations said in a statement.

The organizations suggested that the report may have labeled cases as misdiagnoses that weren't actually.

"The role of the emergency physician is ensuring that the patient is started on the appropriate pathway for the ultimate diagnosis and treatment. An example of this is the patient with recurrent headache. The emergency physician will rule out life-threatening causes and provide pain relief, but the actual diagnosis and definitive treatment often belongs to the follow-up physician," the organizations added.