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Newman-Toker DE, Peterson SM, Badihian S, et al. Diagnostic Errors in the Emergency Department: A Systematic Review [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022 Dec. (Comparative Effectiveness Review, No. 258.)
Results of Literature Searches
Figure B-1 show the literature flow for our searches.
Figure B-1Literature flow diagram
APP = advanced practice provider; CINAHL = Cumulative Index to Nursing and Allied Health Literature; ED = emergency department
* Studies can be excluded for more than one reason.
Results of Grey Literature Searches
Table B-1 displays the results of our review of malpractice claims reports from major medical liability insurance carriers or similar risk management entities.
Table B-1Summary of the status of malpractice claims reports
| Citation | Status |
|---|---|
|
CRICO Strategies. 2011 Annual Benchmarking Report: Malpractice Risks in Emergency Medicine. CRICO Strategies, Cambridge, MA. www | Obtained data relevant to the emergency department from authors and included data in KQ1. |
| Diagnostic Error in Acute Care. Pennsylvania Patient Safety Advisory. 2010: 7(3). | Excluded because no original data. |
|
The Doctors Company. Emergency Medicine Closed Claims Study. www | Excluded because relevant data was not limited to diagnostic errors. |
|
Hanscom
R, Small
M, Lambrecht
A. Diagnostic Accuracy: Room for Improvement. Coverys. www | Excluded because relevant data was not limited to diagnostic errors in the emergency department. |
| Troxel DB. Diagnostic Error in Medical Practice by Specialty. The Doctor’s Advocate. 2014 Sep:2. | Included in KQ1. |
Table B-2Summary of studies reporting on symptom-specific rates of diagnostic error
| Author, Year | Symptom | Country/Region | Population | Diagnostic Error Rate | Harm Rate | Serious Harm Rate |
|---|---|---|---|---|---|---|
| Caterino, 201221 | Infection | US | Adults (65+) | 18.4% (19/103) rate of over-diagnosis | NA | NA |
| Chung, 200922 | Torso imaging | US | NA | 2% (95 of 4768) | 0.3% resulted in change in management or recall to ED (16 of 4768) | No serious harm |
| Crosby, 201316 | Minor head trauma, Testicular pain, Abdominal pain | Western Europe | Pediatrics | Head trauma: 0.3% (by surgeon and/or EM provider); Testicular pain: 1.6% surgeon, 0% EM; Abdominal pain: 1% surgeon, 0.3% EM, P-value sig; Combined three conditions 0.9%, surgeon, 0.3% EM | NA | NA |
| Dubosh, 201511 | Atraumatic headache, Atraumatic back pain | US | Adults | NA | NA | 0.5% headache; 0.2% back pain |
| Ferree, 20161 | Polytrauma | Western Europe | Adults | 12% DDI | 4.2% (% of DDI patients that underwent operative intervention for the DDI) | NA |
| Filippi, 200823 | Neuro MRI | US | NA | 7.2% (26 of 361) | 4.2% (15 of 361) | NA |
| Freedman, 201717 | Constipation | US | Pediatrics | 0.28% (784 of 282,225) | NA | NA |
| Gallagher, 200613 | Abdominal pain | US | Adults | 14.1% (11/78) pts receiving morphine; 14.6% (11/75) pts not receiving morphine | NA | NA |
| Kline, 200920 | Low-risk chest pain | US | Adults | NA | 0.5% missed/delayed ACS in control group, 0% in intervention group (received printout on risk assessment) | NA |
| Kornblith, 20137 | Found down | US | Adults | 16.9% | NA | NA |
| Miller, 201812 | Headache | US | Adults + pediatrics | 0.17 (10/583) | NA | NA |
| Moeller, 200810 | Any neurological complaint (requiring neurology consult) | Canada | NA | 17% between emergency physician and final diagnosis, 19% between ED trainee & final diagnosis, | NA | NA |
| Montmany, 20085 | Polytrauma | Western Europe | Adults (16+) | 40.3% missed injury | 17% clinically significant missed injury | NA |
| Muhm, 20123 | Polytrauma | Western Europe | NA | 23% missed injuries after primary survey, 12% missed after secondary survey, 4% after 24h | 0.20% | NA |
| Osterwalder, 202014 | Abdominal pain | Western Europe | Adults | 5.6% (27/480) | 1.7% requiring surgery | NA |
| Pirozzi, 201419 | Dyspnea | Western Europe | Adults | 5% with POCUS, 50% w/o POCUS (no difference in clinical outcomes/harms between groups) | NA | NA |
| Postma, 20124 | Trauma (flight crash) | Western Europe | NA | NA | 12% clinical significant DDI among hospitalized patients (8 of 66 patients) | 6% (4 of 66 patients required surgery for the delayed diagnosis) |
| Ray, 200618 | Dyspnea/acute respiratory failure | Western Europe | Adults (65+) | 20% (101/514) | NA | NA |
| Royl, 20119 | Dizziness (neurology consulted) | Western Europe | NA | 44% | 6%: primary diagnosis changed from benign to serious; 5% primary serious diagnosis changed to another serious diagnosis | NA |
| Saaristo, 202015 | Abdominal pain | Western Europe | Adults + pediatrics | 3% (303 of 10,609 patients returned to ED w/in 48 hours) | 0.7% hospitalized; 0.06% had immediate surgery. | NA |
| Snoek, 20132 | High-energy trauma | Western Europe | Adults | 2.7% DDI | NA | NA |
| Sun, 20078 | Syncope/near-syncope | US | Adults | 4% | NA | NA |
| Willner, 20126 | Trauma | US | Pediatrics | 8% DDI (26 of 324 patients) | 0.3% clinically significant DDI (1 patient) | NA |
ACS = acute coronary syndrome; DDI = delayed diagnosis of injury; ED = emergency department; EM = emergency medicine; MRI = magenntic resonance imaging; NA = not applicable; POCUS = point-of-care ultrasound; US = United States
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