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Prevalence of Diagnostic Errors in the ICU Assessed

Twenty-eight percent of autopsies report at least one misdiagnosis; 8 percent identify Class I error

THURSDAY, Sept. 6 (HealthDay News) -- Diagnostic errors in the intensive care unit (ICU) are prevalent, with 28 percent of autopsies reporting at least one misdiagnosis, according to a study published online July 21 in BMJ Quality & Safety.

Bradford Winters, M.D., from the Johns Hopkins University School of Medicine in Baltimore, and colleagues reviewed the literature for observational studies examining autopsy-confirmed diagnostic errors in the adult ICU. A total of 31 studies describing 5,863 autopsies were included.

The researchers found that the prevalence of misdiagnoses ranged from 5.5 to 100 percent. At least one misdiagnosis was reported by 28 percent of autopsies, and 8 percent identified a Class I diagnostic error. For a hypothetical autopsy rate of 100 percent, the projected prevalence of Class I misdiagnoses was 6.3 percent. The leading lethal misdiagnoses were vascular events and infections (41 percent each). Pulmonary embolism, myocardial infarction, pneumonia, and aspergillosis were the most common individual Class I misdiagnoses.

"In conclusion, this systematic review and analysis suggests that between 22,600 to 40,500 ICU patients die each year in the United States with, and potentially from, a diagnostic error and many more suffer a clinically relevant diagnostic error," the authors write. "To this point, diagnostic errors have received relatively little attention and research funding, leaving the methods to measure them immature; this must change."

One author provides expert testimony for several defense and plaintiff law firms.

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