Misdiagnoses in hospital intensive care units cause as many as 40,500 deaths a year – about as many as lives lost to breast cancer, a new Johns Hopkins University study finds.
In research published online in the British Medical Journal Quality & Safety, health investigators from the Johns Hopkins Armstrong Institute for Patient Safety and Quality found 28 percent of ICU patients – more than one in four – had at least one missed diagnosis at death.
"Our study shows that misdiagnosis is alarmingly common in the acute care setting," said lead researcher Dr. Bradford Winters, a Johns Hopkins critical care specialist. "To date, there's been very little research to determine root causes or effective interventions."
For the study, researchers reviewed 31 studies including 5,863 autopsies from a wide range of ICU types. By reviewing studies that used autopsy to detect diagnostic errors in adult ICU patients, the researchers found infections, pneumonia and vascular maladies, such as heart attack and stroke, accounted for more than three-quarters of those fatal flaws. In 8 percent of patients, the misdiagnosis was serious enough that it caused or directly contributed to the individual's death.
Winters and his colleagues also found that, when compared with hospital patients overall, critically ill people treated in the ICU face up to a twofold risk of suffering a potentially fatal diagnostic mistake.
"It may be counterintuitive to think that the patients who are the most closely monitored and frequently tested are more commonly misdiagnosed, but the ICU is a very complex environment," Winters said. “We need to develop better cognitive tools that can take into account the 7,000 or more pieces of information that critical care physicians are bombarded with each day to ensure we're not ruling out potential diagnoses."
This study was funded, in part, by the National Institutes of Health.