Every year 80,000 to 160,000 patients in the United States suffer misdiagnosis-related significant permanent injury or death that were possibly preventable, estimate the authors of an analysis published online in BMJ Quality and Safety. Analyzed were 350,706 diagnosis-related claims of medical malpractice reported to the National Practitioner Data Bank over a period of 25 years (1986–2010). The study found that diagnostic errors were the leading type and accounted for the highest proportion of total payments. The most frequent outcomes were death, significant permanent injury, major permanent injury and minor permanent injury. The inflation-adjusted, 25-year sum of diagnosis-related payments was $38.8 billion.
Diagnostic errors more often resulted in death than other allegation groups and were the leading cause of claims-associated death and disability. More diagnostic error claims were outpatient than inpatient (68.8% vs 31.2%, p<0.001), but inpatient diagnostic errors were more likely to be lethal (48.4% vs 36.9%, p<0.001).
The National Practitioner Data Bank is an electronic repository of all payments made on behalf of practitioners in the United States for malpractice settlements or judgments since 1986.
The majority of diagnostic errors were missed diagnoses, rather than delayed or wrong ones. Per-claim payments were highest in cases of serious neurologic harm, including quadriplegia and brain damage resulting in the need for lifelong care.
Diagnostic error means that the diagnosis is missed, wrong or delayed. The harm results from the delay or failure to treat an existing condition or from treatment provided for a condition not actually present.
Due to the frequent gap in time between the when the error occurs and when it is detected, diagnostic errors have been under-appreciated and under-recognized compared to medical and surgical errors, which are evident more immediately.
Among malpractice claims, the number of lethal diagnostic errors was roughly the same as the number that resulted in permanent, severe harm to patients. Since prior estimates were based upon autopsy data that count death but not disability, this finding suggests that the public health impact of these types of mistakes is probably much greater than previously believed.
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