More than 7 million incorrect diagnoses made in US emergency rooms every year, government report finds

By Nadia Kounang, CNN

A new study finds that nearly 6% of the estimated 130 million people who go to US emergency rooms every year are misdiagnosed, which translates to about 1 in 18 patients getting the wrong diagnosis.

The report, published Thursday by the US Department of Health and Human Services’ Agency for Healthcare Research and Quality, reviewed nearly 300 studies published between January 2000 and September 2021. The researchers estimate that 7.4 million misdiagnosis errors are made every year, 2.6 million people receive a harm that could have been prevented, and another 370,000 are permanently disabled or die because of the misdiagnosis. This equates to about 1,400 diagnostic errors every year per emergency room across the country.

The researchers noted that these rates are on par with what is also seen in primary care and hospital inpatient settings.

The top five conditions that were misdiagnosed were:

• stroke
• myocardial infarction
• aortic aneurysm/dissection
• spinal cord compression/injury
• venous thromboembolism

These five conditions accounted for 39% of all serious misdiagnosis-related harms.

Stroke was missed 17% of the time, often because people reported symptoms of dizziness and vertigo. When they entered the ER, 40% of patients who had those two symptoms had their stroke missed initially.

Nonspecific or atypical symptoms were the strongest factor resulting in misdiagnosis, the study found. Women and people of color had a 20% to 30% increase in risk of being misdiagnosed.

Ten of the country’s leading emergency physician groups, including the American College of Emergency Physicians and the American Board of Emergency Medicine, issued a letter to counter the report, which they described as “misleading” and “incomplete.”

The groups say that they recognize there is always room for improvement but that characterizing the diagnoses as errors is incorrect and a misunderstanding of the aim of emergency medicine, which is to focus on the acute and immediate situation.

The letter says that emergency medicine “is rightfully less concerned with diagnosis and more concerned with appropriate stabilization and referral for future evaluation of a symptom complex. … The role of the emergency physician is ensuring that the patient is started on the appropriate pathway for the ultimate diagnosis and treatment.”

The organizations also questioned the studies included in the survey, noting that several of the studies assessed and included in the analysis were from emergency departments from other countries.

The letter says “it is scientifically invalid to extrapolate findings, in particular the calculation of an overall diagnostic error rate, from non-U.S. EDs and compare to the state of emergency care in the U.S.”

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This story has been updated to reflect the studies were published through September 2021.