Systematic Review: About One in 18 Patients Are Misdiagnosed in ED

By Emma Bascom

A report from the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality found that about 7.4 million patients annually are misdiagnosed in the emergency department (ED). The systemic review of 19,127 citations and 279 studies from January 2000 to September 2021 found that in 130 million U.S. ED visits, 5.6% of patients were misdiagnosed, with 2% (2.6 million) patients experiencing a subsequent adverse event. Potentially preventable permanent disabilities or deaths were reported in around 0.3% (370,000) patients. "This translates to about 1 in 18 ED patients receiving an incorrect diagnosis, 1 in 50 suffering an adverse event, and 1 in 350 suffering permanent disability or death," said the researchers. "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." They added that "female sex and non-white race were often associated with important (20%–30%) increases in misdiagnosis risk." The study found that the top five most commonly misdiagnosed conditions, which accounted for 39% of serious misdiagnosis-related harms, were stroke, myocardial infarction, aortic aneurysm/dissection, spinal cord compression/injury, and venous thromboembolism.

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