PMID- 32412440
OWN - NLM
STAT- MEDLINE
DCOM- 20210921
LR  - 20210921
IS  - 2194-802X (Electronic)
IS  - 2194-802X (Linking)
VI  - 8
IP  - 1
DP  - 2021 Feb 23
TI  - 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".
PG  - 67-84
LID - 10.1515/dx-2019-0104 [doi]
AB  - BACKGROUND: Missed vascular events, infections, and cancers account for ~75% of 
      serious harms from diagnostic errors. Just 15 diseases from these "Big Three" 
      categories account for nearly half of all serious misdiagnosis-related harms in 
      malpractice claims. As part of a larger project estimating total US burden of 
      serious misdiagnosis-related harms, we performed a focused literature review to 
      measure diagnostic error and harm rates for these 15 conditions. METHODS: We 
      searched PubMed, Google, and cited references. For errors, we selected 
      high-quality, modern, US-based studies, if available, and best available evidence 
      otherwise. For harms, we used literature-based estimates of the generic 
      (disease-agnostic) rate of serious harms (morbidity/mortality) per diagnostic 
      error and applied claims-based severity weights to construct disease-specific 
      rates. Results were validated via expert review and comparison to prior 
      literature that used different methods. We used Monte Carlo analysis to construct 
      probabilistic plausible ranges (PPRs) around estimates. RESULTS: Rates for the 15 
      diseases were drawn from 28 published studies representing 91,755 patients. 
      Diagnostic error (false negative) rates ranged from 2.2% (myocardial infarction) 
      to 62.1% (spinal abscess), with a median of 13.6% [interquartile range (IQR) 
      9.2-24.7] and an aggregate mean of 9.7% (PPR 8.2-12.3). Serious 
      misdiagnosis-related harm rates per incident disease case ranged from 1.2% 
      (myocardial infarction) to 35.6% (spinal abscess), with a median of 5.5% (IQR 
      4.6-13.6) and an aggregate mean of 5.2% (PPR 4.5-6.7). Rates were considered face 
      valid by domain experts and consistent with prior literature reports. 
      CONCLUSIONS: Diagnostic improvement initiatives should focus on dangerous 
      conditions with higher diagnostic error and misdiagnosis-related harm rates.
CI  - (c)2020 Walter de Gruyter GmbH, Berlin/Boston.
FAU - Newman-Toker, David E
AU  - Newman-Toker DE
AD  - Department of Neurology, The Johns Hopkins University School of Medicine, 
      Baltimore, MD, USA.
AD  - Director, Armstrong Institute Center for Diagnostic Excellence, The Johns Hopkins 
      University School of Medicine, Baltimore, MD, USA.
AD  - Professor, Department of Epidemiology, The Johns Hopkins Bloomberg School of 
      Public Health, Baltimore, MD, USA.
FAU - Wang, Zheyu
AU  - Wang Z
AD  - Department of Oncology, The Johns Hopkins University School of Medicine, 
      Baltimore, MD, USA.
AD  - Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, 
      Baltimore, MD, USA.
FAU - Zhu, Yuxin
AU  - Zhu Y
AD  - Department of Oncology, The Johns Hopkins University School of Medicine, 
      Baltimore, MD, USA.
AD  - Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, 
      Baltimore, MD, USA.
FAU - Nassery, Najlla
AU  - Nassery N
AD  - Department of Medicine, The Johns Hopkins University School of Medicine, 
      Baltimore, MD, USA.
FAU - Saber Tehrani, Ali S
AU  - Saber Tehrani AS
AD  - Department of Neurology, The Johns Hopkins University School of Medicine, 
      Baltimore, MD, USA.
FAU - Schaffer, Adam C
AU  - Schaffer AC
AD  - Department of Patient Safety, CRICO, Boston, MA, USA.
AD  - Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 
      Boston, MA, USA.
FAU - Yu-Moe, Chihwen Winnie
AU  - Yu-Moe CW
AD  - Department of Patient Safety, CRICO, Boston, MA, USA.
FAU - Clemens, Gwendolyn D
AU  - Clemens GD
AD  - Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, 
      Baltimore, MD, USA.
FAU - Fanai, Mehdi
AU  - Fanai M
AD  - Department of Neurology, The Johns Hopkins University School of Medicine, 
      Baltimore, MD, USA.
FAU - Siegal, Dana
AU  - Siegal D
AD  - Director of Patient Safety, CRICO Strategies, Boston, MA, USA.
LA  - eng
PT  - Journal Article
DEP - 20200514
PL  - Germany
TA  - Diagnosis (Berl)
JT  - Diagnosis (Berlin, Germany)
JID - 101654734
SB  - IM
MH  - Diagnostic Errors
MH  - Humans
MH  - Incidence
MH  - *Malpractice
MH  - *Neoplasms/epidemiology
OTO - NOTNLM
OT  - diagnosis
OT  - diagnostic errors
OT  - health services research
OT  - medical errors
OT  - misdiagnosis-related harms
EDAT- 2020/05/16 06:00
MHDA- 2021/09/22 06:00
CRDT- 2020/05/16 06:00
PHST- 2019/12/08 00:00 [received]
PHST- 2020/02/12 00:00 [accepted]
PHST- 2020/05/16 06:00 [pubmed]
PHST- 2021/09/22 06:00 [medline]
PHST- 2020/05/16 06:00 [entrez]
AID - dx-2019-0104 [pii]
AID - 10.1515/dx-2019-0104 [doi]
PST - epublish
SO  - Diagnosis (Berl). 2020 May 14;8(1):67-84. doi: 10.1515/dx-2019-0104. Print 2021 
      Feb 23.