Source/Disclosures
Disclosures:
Newman-Toker reports being a former volunteer president and member of the Board of Directors of the Society to Improve Diagnosis in Medicine. Please see the study for all other authors’ relevant financial disclosures.
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Key takeaways:
- An expert said vascular and infection misdiagnoses are more likely to result in serious harms than cancer misdiagnoses.
- The large burden of diagnostic errors warrants additional efforts to improve diagnoses.
An estimated 795,000 people are permanently disabled or die from misdiagnoses each year in the United States, according to a study recently published in BMJ Quality and Safety.
“In 2015, the National Academy of Medicine stated in their report ‘Improving Diagnosis in Healthcare’ that improving diagnosis was a ‘moral, professional, and public health imperative’ yet also noted that ‘the available research [is] not adequate to extrapolate a specific estimate or range of the incidence of diagnostic errors in clinical practice today,’” David E. Newman-Toker, MD, PhD, a professor of neurology at John Hopkins Medicine, told Healio. “We sought a scientifically robust answer to the question of how many patients in the US suffer serious harms as a result of medical misdiagnosis.”
Newman-Toker and colleagues performed a cross-sectional analysis using 2012 to 2014 hospital discharge data to examine annual vascular and infection incidents and 2014 US registry data to examine annual new cancers. They then multiplied national estimates for diseases in each of the “big three” categories by the proportion of patients with that disease who experienced a misdiagnosis or serious harm.
The researchers found that annually, there were 6 million vascular incidents, 6.2 million infections and 1.5 million cancers in the US The weighted mean diagnostic error and serious harm rates were 11.1% and 4.4%, respectively, per disease case.
The estimated annual number of serious harms was 795,000, but in a sensitivity analysis, this was reduced to 549,000.
The top 15 diseases in each disease category accounted for 50.7% of all serious harms, while the top five diseases — sepsis, venomous thrombosis, stroke, lung cancer and pneumonia — accounted for 38.7%.
Although the researchers expected the annual number of serious harms to be high and were not surprised of the diseases that were often culprits, “we were surprised to see that 15 diseases accounted for 50% of serious harms and the five most frequently harmful accounted for nearly 40% of serious harms,” Newman-Toker said.
Newman-Toker and colleagues suggested that because of the lower number of diseases that contribute heavily to misdiagnoses and serious harms, “meaningful progress” could be made by addressing “just a few dangerous diseases that are relatively common.”
Newman-Toker added that malpractice claims in primary care are often missed cancer diagnoses; however, “it is likely that missed vascular events and infections more often result in serious harms to patients.”
“This is because of the much higher frequency of vascular events (~6 million US cases per year) and infections (~6.2 million US cases per year) relative to cancers (~1.5 million US cases per year), with comparable diagnostic error rates,” he said. “The cancers are likely overrepresented in malpractice claims because there are more opportunities over time to miss a diagnosis and there is often a ‘paper trail’ (eg, a missed lung node on a chest x-ray).”
Future research, Newman-Toker said, should look to heart attack diagnoses in patients with chest pain as a “‘shining star’ example of what can be accomplished when we devote significant resources to addressing the problem of diagnostic error.”
“We found serious harm rates below 1% of heart attack cases,” he said. “Research needs to develop similar, multifaceted solutions for other diseases, such as stroke — we need a mix of teamwork, training, technology, and tuning (feedback) to create multiple safety nets, then studies to demonstrate their impact in real-world practice. We need policy action to increase research funding; new quality metrics and regulatory accountability for good diagnostic outcomes; and new payment models to incentivize accurate, timely, and effectively communicated diagnoses.”
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