Millions Harmed by Medical Misdiagnosis in U.S. Hospital Emergency Rooms
A new study published by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ) on Dec. 15, 2022 estimates that about six percent of the approximately 130 million people (about one in 18 individuals) who seek medical care in emergency departments (ED) in the United States each year are misdiagnosed. This translates into about 7.4 million misdiagnosis errors that cause unnecessary harm to some 2.6 million patients and leave an additional 370,000 patients permanently disabled or dead.1 2 3 4 5
The study researchers from Johns Hopkins University, which reviewed 279 studies published between January 2000 and September 2021 to analyze the frequency and impact of diagnostic errors, found the rates of emergency department misdiagnosis to be similar to those observed in primary care and hospital inpatient care settings.2 3 5 They also found that…
Put in terms of an average ED with 25,000 visits annually and average diagnostic performance, each year this would be over 1,400 diagnostic errors, 500 diagnostic adverse events, and 75 serious harms, including 50 deaths per ED.3 5
Stroke is the Most Misdiagnosed Condition
The following five conditions account for 39 percent of misdiagnosis-related harms: stroke, myocardial infarction, aortic aneurysm/dissection, spinal cord compression/injury and venous thromboembolism. Stroke, which involves a blockage that stops blood supply to tbe brain or when a blood vessel in the brain bursts, is the condition that causes the most harm and is misdiagnosed about 17 percent of the time.1 2 3 4 5
According to the study, the main causes of the diagnostic errors in emergency departments are mostly “cognitive errors linked to the process of bedside diagnosis.”3 Additionally…
Malpractice claims associated with serious misdiagnosis-related harms involved failures of clinical assessment, reasoning, or decision making in about 90 percent of cases. Similar findings were seen in incident report data. These issues are not unique to the ED—they are seen across clinical settings, regardless of study method.3
“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 study noted. “Scalable solutions to enhance bedside diagnostic processes are needed, and these should target the most commonly misdiagnosed clinical presentations of key diseases causing serious harms.”3 4
Misdiagnosis: The ‘Elephant in the Room’
The problem of emergency department misdiagnosis was described as “the elephant in the room no one is paying attention to” by professor of neurology David Newman-Toker, MD, PhD, director of Johns Hopkins’ Armstrong Institute Center for Diagnostic Excellence and one of the study’s researchers. It is part of a broader problem of medical errors involving the U.S. health care system, which account for 10 percent of deaths in the U.S. annually and some $20 billion in costs to the country.2 6 7 8
In 2020, a white paper released by the Foundation for the Innovation and Development of Health Safety found that 20-25 percent of patients are harmed by medical errors in primary and outpatient care in the U.S. and Europe, as well as in many developing countries. The report found that 25 percent of preventable harm done to patients was caused by mismanagement in the way drugs were administered and that, in the U.S. alone, adverse reactions to drugs were responsible for nearly 700,000 emergency room visits and over 100,000 hospitalizations every year.9
The problem of medical errors leading to millions of deaths over the past decades is a long-standing problem in U.S. healthcare. In 2000, the Institute of Medicine, National Academy of Sciences, published a report To Err is Human: Building a Safer Health System, which revealed that medical errors in U.S. hospitals were a leading cause of death. Authors of the report said:
Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals That’s more than die from motor vehicle accidents, breast cancer, or AIDS–three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems.10
By 2016, Johns Hopkins University patient safety researchers reported that more than 250,000 deaths per year in the U.S. can be attributed to medical errors.7 11
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