Podcast 856: ED Errors and Counterstudy

Contributor: Nicholas Tsipis, MD

Educational Pearls:

What study was Dr. Tsipis talking about?

• In December of 2022, the Agency for Healthcare Research and Quality (AHRQ) put out a study titled "Diagnostic Errors in the Emergency Department: A Systematic Review."

• This study triggered many news stories from prominent outlets with headlines such as, "More than 7 million incorrect diagnoses made in US emergency rooms every year, government report finds," from CNN, and "E.R. Doctors Misdiagnose Patients With Unusual Symptoms," from the New York Times.

What was the response?

• Matt Bivens, MD from Emergency Medicine News responded to the original study in an article titled, "AHRQ Errors Report was 'Outright Unconscionable.'"

• Dr. Bivens points out that AHRQ's biggest claims – including that 5.7% of patients are misdiagnosed in the ED and 2.0% suffer an adverse event as a result – were based only on three small studies out of Canada, Spain, and Switzerland (combined n=1,758).

• Spain and Switzerland did not have emergency medicine residency-trained physicians at the time of the studies.

• The Swiss study looked at when the diagnosis changed significantly between admittance and discharge to which Bivens responded, "Are we describing errors in this study or just an ongoing collaborative process?"

• The Canadian study looked at 503 high-acuity patients of which one died of a missed aortic dissection. Bivens notes that this is too small of sample size to be generalized to the American ER population which includes a mix of low and high acuity.

Moral of the story?

• Mistakes do happen in the ED and they do negatively impact patients but be careful in how you interpret studies and news articles that report on them.

References

• Newman-Toker DE, Peterson SM, Badihian S, Hassoon A, Nassery N, Parizadeh D, Wilson LM, Jia Y, Omron R, Tharmarajah S, Guerin L, Bastani PB, Fracica EA, Kotwal S, Robinson KA. Diagnostic Errors in the Emergency Department: A Systematic Review. Comparative Effectiveness Review No. 258. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 75Q80120D00003.) AHRQ Publication No. 22(23)-EHC043. Rockville, MD: Agency for Healthcare Research and Quality; December 2022. DOI: 10.23970/AHRQEPCCER258.

• Kounang, N. (2022, December 16). More than 7 million incorrect diagnoses made in US emergency rooms every year, government report finds. CNN. https://www.cnn.com/2022/12/15/health/hospital-misdiagnoses-study/index.html

• Abelson, R. (2022, December 15). E.R. Doctors Misdiagnose Patients With Unusual Symptoms. The New York Times. https://www.nytimes.com/2022/12/15/health/medical-errors-emergency-rooms.html?searchResultPosition=3

• Bivens, Matt MD. Evidence-Based Medicine: AHRQ Errors Report was 'Outright Unconscionable'. Emergency Medicine News 45(3):p 1,21, March 2023. | DOI: 10.1097/01.EEM.0000922716.51556.31

Summarized by Jeffrey Olson, MS1 | Edited by Meg Joyce & Jorge Chalit, OMSII