News: Vascular events, infections, cancers responsible for most diagnostic error harm

Misdiagnoses in treatments for “big three” conditions—cardiovascular events, cancers, and infections—comprise 74% of all serious harms from diagnostic errors, according to a new study published in Diagnosis.

The study also found that 34% of malpractice cases for death or permanent disability began with an errant or delayed diagnosis, making it the biggest cause of serious harms among medical errors, HealthLeaders Media reported.

“We know that diagnostic errors happen across all areas of medicine. There are over 10 thousand diseases, each of which can manifest with a variety of symptoms, so it can be daunting to think about how to even begin tackling diagnostic problems,” said study lead author David Newman-Toker, MD, director of the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence, in remarks accompanying the report.

“Our findings suggest that the most serious harms can be attributed to a surprisingly small number of conditions. It still won’t be an easy or quick fix, but that gives us both a place to start and real hope that the problem is fixable,” he said.

Sifting through reams of malpractice insurance claims in the national Comparative Benchmarking System database, the researchers analyzed all 11,592 diagnostic error cases between 2006 and 2015 that resulted in $1.8 billion in malpractice payouts over the decade.

“We use malpractice claims to track this issue because there aren’t many measures for diagnostic error.  It’s not so much that they are prone to litigation—it is that they often result in significant harm and that can lead to litigation,” Newman-Toker said.

They found that misdiagnoses were the most common, catastrophic, and costly medical mistakes. Specifically, diagnostic errors that led to death or permanent disability were linked with misdiagnosed cancers (37.8%), vascular events (22.8%) and infections (13.5%) — which led the researchers to refer to them as the “big three,” according to HealthLeaders Media.

Within those three areas, the researchers identified 15 specific conditions that combined account for nearly half of all the serious, misdiagnosis-related harms.

The top conditions in each category are stroke, sepsis, and lung cancer, respectively. Other most-commonly misdiagnosed conditions include heart attack, venous thromboembolism, aortic aneurysm and dissection, arterial thromboembolism, meningitis and encephalitis, spinal infection, pneumonia, endocarditis, and breast, colorectal, prostate, and skin cancers.

Half of the most-severe harm cases ended in patient death and the other half resulted in permanent disability, the researchers report, HealthLeaders Media reported.

The claims data show that failures of clinical judgment caused more than 85% of the misdiagnosed cases. The researchers said those findings demonstrates that health systems must do more to support clinicians' bedside diagnoses, improve access to specialists, nurture clinician teamwork, and encourage patient engagement in the diagnoses.

The Hopkins researchers also found that 71% of the diagnostic errors took place either in outpatient clinics, where misdiagnoses were often cancer-related, or emergency departments, a common source of missed infections and vascular events.

Editor’s note: This article originally appeared in HealthLeaders Media. To read about common denial rationale for acute kidney disease and acute tubular necrosis, which includes misdiagnosis, click here.