When an urgent health problem means a trip to the emergency room, getting the right diagnosis quickly is critical, while the wrong one can have serious or even fatal consequences. A recent Johns Hopkins study, conducted on behalf of the Agency for Healthcare Research and Quality, looked into how often people are misdiagnosed in the ER, what conditions are most commonly missed, and what that means for patients’ long-term survival.
The good news is, the team found that overall diagnostic accuracy in the ER is very high, generally over 94%. However, about 5.7% of patients receive an incorrect diagnosis, which translates to about one in every 18 people – or 7.4 million Americans who visit the ER annually. Of those, as many as 250,000 people may die every year due to misdiagnosis in the emergency room.
Five conditions were found to be most often misdiagnosed, in order of prevalence: stroke, heart attack, aortic aneurysm/dissection, spinal cord compression/injury, and venous thromboembolism (blood clot). They account for roughly 40% of serious harms among misdiagnosed patients.
For a given disease, an incorrect diagnosis is more likely for someone who arrives at the hospital with nonspecific, atypical or milder symptoms. For example, having dizziness or vertigo rather than motor symptoms increases the odds of a missed stroke diagnosis 14-fold.
Being in a certain demographic group can also impact a patient’s misdiagnosis risk. Strokes and heart attacks are more frequently missed in younger people, while conditions like appendicitis are more often missed in older ones. Women and minorities generally face a 20-30% overall higher risk of being misdiagnosed.
It’s important to note, however, that the report’s findings have received strong criticism from some medical professionals, including emergency room doctors.
“In addition to making misleading, incomplete and erroneous conclusions from the literature reviewed, the report conveys a tone that inaccurately characterizes and unnecessarily disparages the practice of emergency medicine in the United States,” Dr. Christopher S. Kang, president of the American College of Emergency Physicians, said in a statement. “As with all medical specialties, there is room for improvement in the diagnostic accuracy of emergency care. All of us who practice emergency medicine are committed to improving care and reducing diagnostic error.”