AI Article Synopsis

  • Diagnostic error, particularly related to missed acute myocardial infarctions (AMI) in emergency departments, is a significant public health concern, prompting the use of the SPADE method to evaluate associated harms.
  • A retrospective analysis from 2009 to 2017 identified 2,874 treat-and-release ED visits connected to 44,473 AMI hospitalizations, with 'chest pain' and 'dyspnea' being the most common symptoms linked to missed diagnoses.
  • The findings suggest that approximately 10,000 potentially preventable harms occur annually in the US due to missed AMIs, but the relatively low rates of diagnostic errors and harm may complicate efforts to reduce these incidents.

Article Abstract

Objectives: Diagnostic error is a serious public health problem. Measuring diagnostic performance remains elusive. We sought to measure misdiagnosis-related harms following missed acute myocardial infarctions (AMI) in the emergency department (ED) using the symptom-disease pair analysis of diagnostic error (SPADE) method.

Methods: Retrospective administrative data analysis (2009-2017) from a single, integrated health system using International Classification of Diseases (ICD) coded discharge diagnoses. We looked back 30 days from AMI hospitalizations for antecedent ED treat-and-release visits to identify symptoms linked to probable missed AMI (observed > expected). We then looked forward from these ED discharge diagnoses to identify symptom-disease pair misdiagnosis-related harms (AMI hospitalizations within 30-days, representing diagnostic adverse events).

Results: A total of 44,473 AMI hospitalizations were associated with 2,874 treat-and-release ED visits in the prior 30 days. The top plausibly-related ED discharge diagnoses were "chest pain" and "dyspnea" with excess treat-and-release visit rates of 9.8% (95% CI 8.5-11.2%) and 3.4% (95% CI 2.7-4.2%), respectively. These represented 574 probable missed AMIs resulting in hospitalization (adverse event rate per AMI 1.3%, 95% CI 1.2-1.4%). Looking forward, 325,088 chest pain or dyspnea ED discharges were followed by 508 AMI hospitalizations (adverse event rate per symptom discharge 0.2%, 95% CI 0.1-0.2%).

Conclusions: The SPADE method precisely quantifies misdiagnosis-related harms from missed AMIs using administrative data. This approach could facilitate future assessment of diagnostic performance across health systems. These results correspond to ∼10,000 potentially-preventable harms annually in the US. However, relatively low error and adverse event rates may pose challenges to reducing harms for this ED symptom-disease pair.

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Source
http://dx.doi.org/10.1515/dx-2020-0049DOI Listing

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