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Criticism of a major review of Emergency Department (ED) diagnostic errors began almost as soon as the study was published.

The research, spearheaded by Johns Hopkins University Evidence-based Practice Center, made headlines. Titles like “More than 7 million incorrect diagnoses made in US emergency rooms every year, government report finds,” grabbed attention and quickly polarized the healthcare community involved in emergency care.

 Prepared for the Agency for Healthcare Research and Quality (AHRQ), the report included healthcare data between January 2000 and September of 2021 that discussed diagnostic error and ED misdiagnosis in the US.  Overall, authors identified 279 applicable studies with 19,127 citations from which to create their study.

According to the study, the top five areas likely to be associated with ED related misdiagnosis include stroke, heart attack, aortic aneurysm and dissection, spinal cord injury and venous thromboembolism. As well, researchers suggest that 7.4 million patients are misdiagnosed each year during 130 million ED visits, among other findings.

Following publication, it did not take long for the ED community to highlight concerns about the report. One commentator, Dr. Jeremy Faust, wrote that the research drew critical concern from internal reviewers prior to publication.  One reviewer reflected “This section has a fatal flaw and should be removed, specifically, any national extrapolation. Headline grabbing, yes, but this is at best gravely misleading.”

As well, criticisms were leveled at the amount of data used to create estimates of misdiagnosis rates of EDs in the US. Other concerns were expressed during the public comment period for the publication, but were not incorporated into the paper, including one commentator who pointed out several statistical errors in the report.

One peer reviewer remarked that he understood why the industry was unhappy with the results, given the lack of high-quality studies available to support the estimates that were provided in the report.  The reviewer, Dr. Mark Graber noted, “It does point out the need for much more research in this area.” 

At the time of this writing, there is a note on the AHRQ website that says, “This report is currently under review by AHRQ.” Correct or incorrect numbers?  It is a dismal reflection on efforts to reduce misdiagnosis in any area when the experts cannot agree when and where it is happening.

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