Nearly One-in-Ten Vascular Events, Infections, and Cancers are Misdiagnosed

Dana Siegal, RN, CPHRM

A new analysis examining rates of medical misdiagnoses in the US has returned startling results—suggesting nearly 1 in 10 patients in the US with a major vascular event, infection, or cancer will be misdiagnosed.

Using data from 28 different studies, results of the Johns Hopkins University-led study analyzed condition-specific diagnostic error rates across 15 conditions and found 9.6% of patients with these conditions were misdiagnosed.

"With this insight, health care leaders and clinicians can focus their resources and interventions to target these vulnerabilities," said study investigator Dana Siegal, RN, CPHRM, director of Patient Safety at CRICO Strategies, in a statement.

Funded by the Society to Improve Diagnosis in Medicine, investigators designed their study to assess rates of diagnostic error and serious misdiagnosis-related harm rates through an analysis of the multiple databases. Using PubMed, Google Scholar, and personal files for relevant citations, investigators identified a total of 28 studies including data from 91,755 patients for their analysis.

The analysis examined 5 conditions in each of the 3 disease categories examined in the analysis.

Major vascular events included stroke, myocardial infarction (MI), venous thromboembolism (VTE), aortic aneurysm and dissection, arterial embolism. Infections examined included sepsis, meningitis and encephalitis, spinal abscess, pneumonia, endocarditis. Cancers examined included lung cancer, breast cancer, colorectal cancer, prostate cancer, and melanomas.

Investigators defined a diagnostic error was defined as the failure to establish an accurate and timely explanation of the patient’s health problem or failure to communicate that explanation to the patient. Severity of harm caused by misdiagnosed was defined according to the National Association of Insurance Commissions (NAIC) Severity of injury scale.

Total study sample sizes varied between the 3 disease categories examined, with the total per-disease individual study sample sizes were greatest for cancers (mean 14,690; median 11,860), intermediate for vascular events (mean 3068; median 1532), and least for infections (mean 593, median 309). Overall, disease-specific diagnostic error rates ranged from 2.2%, which was seen with MI, to 62.1%, which was the rate noted for spinal abscess. Investigators noted a median disease-specific rate of diagnostic error of 13.6% (IQR, 9.2-24.7). Results indicated the aggregate mean rate of diagnostic error for all the 15 conditions included in the study was 9.7% (PPR, 8.2-12.3).

In regard to serious misdiagnosis-related harm, rates ranged from 1.2%, which was seen with MI, to 35.6%, which was the rate noted for spinal abscess. Investigators noted a median of 5.5% (IQR, 4.6-13.6) and an aggregate mean of 5.2% (PPR, 4.5-6.7) when examining all 15 diseases.

Investigators highlighted results suggested almost 1-in-4 lung cancer diagnoses are delayed due to an error in diagnosis (22.5%; PPR, 11.4-37.8). Additionally, delays in diagnosis due to misdiagnosis errors were greater than 20% for aortic aneurysm and dissection (27.9%; CI, 25.6-30.2), arterial thromboembolism (23.9%; CI, 18.9-29.5), endocarditis (25.5%; CI, 21.7-29.6), and meningitis and encephalitis (25.6%; 95% CI, 20.8-30.8).

This study, “Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the “Big Three”,” was published in Diagnosis.