Study Says Up To 160,000 Injured Or Killed By Diagnosis Error Annually

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Researchers at John’s Hopkins reviewed over 350,000 malpractice claim payouts in the U.S over the past 25 years found in the National Practitioner Data Bank. They found that the majority of these claims were the result of diagnostic error, often resulting in severe injury to patients and constituting the highest payouts.

The leader of the study, which was published in BMJ Quality and Safety, David E. Newman-Toker, M.D., Ph.D., an associate professor of neurology at the Johns Hopkins University School of Medicine, said “This is more evidence that diagnostic errors could easily be the biggest patient safety and medical malpractice problem in the United States. There’s a lot more harm associated with diagnostic errors than we imagined.”

The study only looks at incidents for which medical malpractice claims were filed and paid out. The true number of such incidents is estimated to be 80,000 to 160,000 patients suffering misdiagnosis-related injury or death in the U.S each year say the researchers. Researchers from Hopkins previously found that in the U.S. surgeons leave a foreign object such as a surgical sponge inside their patients 39 times per week.

The existence of diagnostic errors are confirmed through additional testing or physical findings, and they result in failure to adequately treat the patient’s underlying condition. Twice as many diagnostic errors were seen in outpatient patients, however inpatient patients were more likely to die. Most of the errors were failure to diagnose rather than mistaken diagnosis. Some experts have estimated that up to 15% of patients are misdiagnosed when seeing a physician for the first time for their medical condition.

Abstract from the study:

Background We sought to characterize the frequency, health outcomes and economic consequences of diagnostic errors in the USA through analysis of closed, paid malpractice claims.

Methods We analysed diagnosis-related claims from the National Practitioner Data Bank (1986–2010). We describe error type, outcome severity and payments (in 2011 US dollars), comparing diagnostic errors to other malpractice allegation groups and inpatient to outpatient within diagnostic errors.

Results We analysed 350?706 paid claims. Diagnostic errors (n=100?249) were the leading type (28.6%) and accounted for the highest proportion of total payments (35.2%). The most frequent outcomes were death, significant permanent injury, major permanent injury and minor permanent injury. Diagnostic errors more often resulted in death than other allegation groups (40.9% vs 23.9%, p<0.001) and were the leading cause of claims-associated death and disability. More diagnostic error claims were outpatient than inpatient (68.8% vs 31.2%, p<0.001), but inpatient diagnostic errors were more likely to be lethal (48.4% vs 36.9%, p<0.001). The inflation-adjusted, 25-year sum of diagnosis-related payments was US$38.8 billion (mean per-claim payout US$386?849; median US$213?250; IQR US$74?545–484?500). Per-claim payments for permanent, serious morbidity that was ‘quadriplegic, brain damage, lifelong care’ (4.5%; mean US$808?591; median US$564?300), ‘major’ (13.3%; mean US$568?599; median US$355?350), or ‘significant’ (16.9%; mean US$419?711; median US$269?255) exceeded those where the outcome was death (40.9%; mean US$390?186; median US$251?745).

Conclusions Among malpractice claims, diagnostic errors appear to be the most common, most costly and most dangerous of medical mistakes. We found roughly equal numbers of lethal and non-lethal errors in our analysis, suggesting that the public health burden of diagnostic errors could be twice that previously estimated. Healthcare stakeholders should consider diagnostic safety a critical health policy issue.

From 25-Year summary of US malpractice claims for diagnostic errors 1986–2010: an analysis from the National Practitioner Data Bank

British Medical Journal Quality & Safety

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