July 27, 2019

A study published online on July 11, 2019 in the medical journal Diagnosis, the Official Journal of the Society to Improve Diagnosis in Medicine (SIDM), found that vascular events, infections, and cancers account for about three-fourths of serious misdiagnosis-related harms (morbidity/mortality) in the closed medical malpractice cases that the authors analyzed.

The study’s authors identified diagnostic error medical malpractice cases from a database representing 28.7% of all medical malpractice cases in the United States from 2006 through 2015. From 55,377 closed medical malpractice claims, the authors analyzed 11,592 diagnostic error cases that included 7,379 with high-severity harms (53.0% death). Vascular events, infections, and cancers (which the authors deemed “the Big Three diseases”) accounted for 74.1% of high-severity cases (vascular events 22.8%, infections 13.5%, and cancers 37.8%). The authors found that the most frequent disease in each category, respectively, was stroke, sepsis, and lung cancer, and causes were disproportionately clinical judgment factors (85.7%) across categories. The authors determined that the Big Three diseases accounted for 61.7% of all diagnostic error claims and 67.3% of all diagnostic error payouts.

The authors stated that their main goal of the study was to identify the list of top diseases that, when missed, cause serious harms so that in later research steps they could measure their annual incidence, frequency of diagnostic errors, and risk of harm to approximate incident harms. The authors stated: “Diagnostic error is recognized as a major source of preventable harms in US healthcare, but current estimates of aggregate misdiagnosis-related harms vary widely. Estimates combining autopsy-detected error rates and total hospital deaths suggest perhaps 40,000–80,000 misdiagnosis-related deaths in US hospitals annually. Estimates from national malpractice data suggest that serious morbidity is at least as common as death, translating to roughly 80,000–160,000 serious misdiagnosis-related harms each year. Estimates extrapolating from diagnostic error rates in specific research studies suggest that 12 million Americans suffer a diagnostic error each year in primary care alone. The same studies found 33% of these diagnostic errors resulted in “serious permanent damage” or “immediate or inevitable death.” This would translate to at least 4 million seriously harmed, including at least 1.7 million who died from diagnostic error. If correct, then >60% of the 2.7 million deaths annually in the US would be attributable to diagnostic error, which seems implausible, given that previous estimates of attributable deaths from multiple systematic reviews of autopsy studies indicate that the proportion is likely closer to 5–10%.”

The authors found that more than half of the high-severity harm cases involved claims against four disciplines: internal medicine, emergency medicine, family medicine, and radiology. Vascular events were the leading claims in emergency medicine, cardiology, hospital medicine, and neurology. Infections were the leading claims in pediatric care. Cancers were the leading claims in radiology, internal medicine, family medicine, pathology, gynecology, gastroenterology, urology, general surgery, dermatology, otolaryngology, pulmonology, and oncology. Overall, roughly half of the cases involved general care clinicians. The authors stated that the distribution of the Big Three diseases in claims appears to be skewed toward cancer cases, which account for a greater fraction of claims cases than vascular events and infections combined.


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