Improving diagnosis in health care is a moral, professional and public health imperative, according to the U.S. National Academy of Medicine. However, little is known about the full scope of harms related to medical misdiagnosis – current estimates range widely. Using novel methods, a team from the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence and partners from the Risk Management Foundation of the Harvard Medical Institutions sought to derive what is believed to be the first rigorous national estimate of permanent disability and death from diagnostic error.
That is the first paragraph of a press release from Johns Hopkins (https://www.hopkinsmedicine.org/news/newsroom/news-releases/report-highlights-public-health-impact-of-serious-harms-from-diagnostic-error-in-us). The published report is at https://qualitysafety.bmj.com/content/early/2023/07/16/bmjqs-2021-014130, but the press release summarizes it very well and also includes some illuminating remarks by the lead investigator.
“Prior work has generally focused on errors occurring in a specific clinical setting, such as primary care, the emergency department or hospital-based care,” says David Newman-Toker, M.D., Ph.D., lead investigator and director of the Center for Diagnostic Excellence. “These studies could not address the total serious harms across multiple care settings, the previous estimates of which varied widely from 40,000 to 4 million per year. The methods used in our study are notable because they leverage disease-specific error and harm rates to estimate an overall total.”
[R]esearchers multiplied national measures of disease incidence by the disease-specific proportion of patients with that illness who experience errors or harms. Researchers repeated this method for the 15 diseases causing the most harms…. The resulting national estimate of 371,000 deaths and 424,000 permanent disabilities reflects serious harms widely across care settings….
.… The study found that 15 diseases account for 50.7% of the total serious harms. Five conditions causing the most frequent serious harms account for 38.7% of total serious harms: stroke, sepsis, pneumonia, venous thromboembolism and lung cancer. The overall average error rate across diseases was estimated at 11.1%, but the rate ranges widely from 1.5% for heart attack to 62% for spinal abscess. The top cause of serious harm from misdiagnosis was stroke, which was found to be missed in 17.5% of cases…. (Emphasis added.)
“A disease-focused approach to diagnostic error prevention and mitigation has the potential to significantly reduce these harms,” Newman-Toker says. “Reducing diagnostic errors by 50% for stroke, sepsis, pneumonia, pulmonary embolism and lung cancer could cut permanent disabilities and deaths by 150,000 per year.”
It interests me that today, 46 years after I got my first job at a boutique plaintiff personal injury firm, spinal abscess has (still has?) the highest diagnostic error rate. One of the first cases I worked on involved a failure to diagnose an epidural abscess. A college student had walked (with difficulty) into Rhode Island Hospital’s emergency department. He had classic symptoms of an epidural abscess. To be fair, his symptoms could have been due to other conditions (hence the high error rate). Over the next 6 hours, while the attending physicians tried to figure out what was going on, the young man developed irreversible spinal cord damage and wound up paraplegic. Meanwhile, a first year orthopedic surgery resident made the correct diagnosis, and entered it in the chart, early enough that drainage and/or surgery would have prevented that outcome. Evidently the attendings were not interested in his opinion. That note in the chart is the reason we won the case.
Misdiagnoses and delayed diagnoses that cause permanent disability or death often lead to medical malpractice litigation. Vident Partners has experts in every medical and surgical specialty and subspecialty. Our clients include both plaintiff and defense attorneys. We stand ready to assist you the next time you need help finding an expert.
