Study details dangers of ER misdiagnoses

Links problems to possible deaths of 250,000 in US

As many as 250,000 people die every year because they are misdiagnosed in the emergency room, with doctors failing to identify serious medical conditions including stroke, sepsis, and pneumonia, according to a new analysis from the federal government.

The study, released Thursday by the Agency for Healthcare Research and Quality, estimates roughly 7.4 million people are inaccurately diagnosed of the 130 million annual visits to hospital emergency departments in the United States. Some 370,000 patients may suffer serious harm as a result.

Researchers from Johns Hopkins University, under a contract with the agency, analyzed data from two decades’ worth of studies to quantify the rate of diagnostic errors in the emergency room and identify serious conditions where doctors are most likely to make a mistake. Many of the studies were based on incidents in European countries and Canada, leading some officials of US medical organizations to criticize the researchers’ conclusions.

While these errors remain relatively rare, they are most likely to occur when someone presents with symptoms that are not typical, such as stroke patients complaining the room is spinning.

A doctor may not immediately think that a young woman with shortness of breath is having a heart attack or that someone who has back pain could have a spinal abscess.

“This is the elephant in the room no one is paying attention to,” said Dr. David E. NewmanToker, a neurologist at Johns Hopkins University and director of its Armstrong Institute Center for Diagnostic Excellence, and one of the study’s authors.

The findings underscore the need to look harder at where errors are being made and the medical training, technology, and support that could help doctors avoid them, NewmanToker said. “It’s not about laying the blame on the feet of emergency room physicians,” he said.

In reviewing the studies, the researchers also found that women and people of color had a roughly 20 percent to 30 percent higher risk of being misdiagnosed. While these results are not surprising, they point to the need to address how different patients are assessed in the emergency room as part of the effort to improve care, said Jennie Ward-Robinson, CEO of the Society to Improve Diagnosis in Medicine.

Medical societies representing emergency room doctors strongly criticized the study. “In addition to making misleading, incomplete, and erroneous conclusions from the literature reviewed, the report conveys a tone that inaccurately characterizes and unnecessarily disparages the practice of emergency medicine in the United States,” Dr. Christopher S. Kang, president of the American College of Emergency Physicians, said in a statement.

“As with all medical specialties, there is room for improvement in the diagnostic accuracy of emergency care,” Kang added. “All of us who practice emergency medicine are committed to improving care and reducing diagnostic error.”

The study’s authors acknowledged the need to do more research.