Each year as many as 40,500 critically ill U.S. hospital patients die with an unknown medical condition that may have caused or contributed to their death, Johns Hopkins patient safety experts report in a recent study.
In a discussion of their findings, described online in BMJ Quality & Safety, researchers say that although diagnostic errors in the intensive care unit (ICU) may claim as many lives each year as breast cancer, they remain an underappreciated cause of preventable patient harm.
"Our study shows that misdiagnosis is alarmingly common in the acute care setting," says Bradford Winters, M.D., Ph.D., lead author and associate professor of anesthesiology and critical care medicine and neurology and surgery in the Johns Hopkins University School of Medicine. "To date, there's been very little research to determine root causes or effective interventions," Winters says, noting that less lethal patient safety risks have received greater attention.
By reviewing studies that used autopsy to detect diagnostic errors in adult ICU patients, the experts in the Johns Hopkins Armstrong Institute for Patient Safety and Quality discovered that 28 percent of patients more than one in four had at least one missed diagnosis at death. In 8 percent of patients, the diagnostic error was serious enough that it may either have caused or directly contributed to the individual's death and, if known, likely would have changed treatment, researchers say. Infections and vascular maladies, such as heart attack and stroke, accounted for more than three-quarters of those fatal flaws.
Overall, the medical conditions most commonly missed by diagnosticians included heart attack; pulmonary embolism, an artery blockage in the lungs; pneumonia; and aspergillosis, a fungal infection that most commonly affects individuals with a weakened immune system. Cumulatively, these four conditions accounted for about one-third of all illnesses that doc
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Johns Hopkins Medicine