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Johns Hopkins team finds ICU misdiagnoses may account for as many annual deaths as breast cancer
Date:8/27/2012

tors failed to detect.

Their review of 31 studies included 5,863 autopsies from a wide range of ICU types. The prevalence of autopsy-detected misdiagnoses, which were stratified by severity, ranged from 5.5 to 100 percent by study. Winters and his team categorized misdiagnoses based on four categories: vascular, which included conditions involving vessel blockages and bleeding, such as heart attack and stroke; all bacterial, viral and fungal infections; mechanical pathophysiological, a broad range of organ malfunction such as congestive heart failure and bowel obstruction; and cancer/other.

After collecting and classifying all error data, the researchers calculated how frequently misdiagnoses would be discovered if every patient who died in the ICU underwent an autopsy. Although autopsy is more frequently performed in complex patient cases in which the clinician may have a lower level of diagnostic certainty, the authors took this potential bias into account. Based on those adjustments, they say their calculations are conservative estimates.

Winters and his colleagues also found that, when compared with adult hospital patients overall, individuals in the ICU face up to a twofold risk of suffering a potentially fatal diagnostic mistake.

"It may be counterintuitive to think that the patients who are the most closely monitored and frequently tested are more commonly misdiagnosed, but the ICU is a very complex environment," Winters says. Clinicians face a deluge of information in a distracting environment in which the sickest patients compete for attention, most without being able to communicate with their medical team. "We need to develop better cognitive tools that can take into account the 7,000 or more pieces of information that critical care physicians are bombarded with each day to ensure we're not ruling out potential diagnoses," Winters says.

Although two-thirds of discovered misdiagnoses did not directly contr
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Contact: Shannon Swiger
sswiger1@jhmi.edu
443-287-8560
Johns Hopkins Medicine
Source:Eurekalert

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