One in four ICU patients may have a missed diagnosis at death

Submitted by Aspergillus Administrator on 5 September 2012

A new publication from The John Hopkins University studying acute care patients has revealed that up to 28% of adult ICU patients may have one or more misdiagnoses at death. In the US that means as many as 40,500 adult ICU patients in the country may die with a misdiagnosis every year.

The study reviewed more than 5,800 postmortems, researchers found that 28 percent of patients had a missed diagnosis the main ones including : heart attack, pulmonary embolism, artery blockage of the lungs, pneumonia and aspergillosis. Potentially these diagnostic errors could have contributed to or directly caused the patient’s death.

The study was published in BMJ Quality and Safety and the research took into account that autopsies are more commonly performed on complex patients.
 Bradford Winters (Associate Professor at John Hopkins) said that although diagnostic errors in the intensive care unit (ICU) may claim as many lives each year as breast cancer, they remain an under-appreciated cause of preventable patient harm.  If diagnosed in time they very  likely would have changed treatment, researchers say.

 Infections and vascular maladies, such as heart attack and stroke, accounted for more than three-quarters of those fatal flaws. 
Even though two-thirds of misdiagnosed cases may not have contributed to death, the authors note that the errors could lead to longer hospital stays, unnecessary surgery and poorer quality of life for the patients who survive.
Dr Winters concluded that “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,” Winters says. 
 The study points to the need for additional research to pinpoint the causes of misdiagnosis and identify tools to help diagnosticians more accurately assess patients in the ICU setting.