Serious Misdiagnosis-Related Harms Mostly Due to 'Big Three'

Vascular events, infections, and cancers account for about three-quarters of serious misdiagnosis-related harms, according to a study published online in Diagnosis.

David E. Newman-Toker, M.D., Ph.D., from the Johns Hopkins University School of Medicine in Baltimore, and colleagues conducted a cross-sectional analysis of a large medical malpractice database to estimate the U.S. burden of serious misdiagnosis-related harms. Diseases accounting for the majority of serious misdiagnosis-related harms were identified. A total of 11,592 diagnostic error cases were analyzed from 55,377 closed claims, including 7,379 with high-severity harms (53.0 percent death).

The researchers found that vascular events, infections, and cancers accounted for 74.1 percent of high-severity cases (22.8, 13.5, and 37.8 percent, respectively). The top five from each category accounted for 47.1 percent of high-severity cases. In each category, the most frequent disease was stroke, sepsis, and lung cancer, respectively. Across categories, causes were disproportionately clinical judgement factors (85.7 percent; range, 82.0 to 88.8 percent).

"Serious harms are disproportionately due to failures in clinical judgment, rather than problems with communication or closing the loop on test results; this suggests it will be necessary to develop systems solutions to solve cognitive problems," the authors write. "Research and quality improvement initiatives should target interventions that improve clinical diagnosis for high-harm diseases in specific practice settings such as stroke in the emergency department, sepsis in the hospital, and lung cancer in primary care."

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