ICU Patients: Twice As Likely to Suffer Fatal Misdiagnosis

You would think that patients in a hospital's intensive care unit would be the least likely to worsen or die simply because someone misdiagnosed their condition.

Unfortunately, you would be wrong, say patient safety experts with Johns Hopkins University in a new study.

Despite all the tests and close monitoring of ICU patients, researchers found that these patients face twice the risk of a fatal diagnostic error as compared with adult hospital patients overall.

In fact, as many as 40,500 critically ill hospital patients die each year because they were misdiagnosed, researchers said. That's equivalent to the number killed yearly by breast cancer - a finding that the lead author of the study called "surprising and alarming."

The problems the study found were errors of omission - "not something you did, but something you didn't do" - study author Bradford Winters, M.D., associate professor of critical care medicine at the Johns Hopkins School of Medicine, told The Atlantic magazine. Had the correct diagnosis been made, he said, patient treatment might have been changed and lives potentially saved.

The ICU is a complex, distracting environment in which physicians are bombarded daily with 7,000 or more pieces of information, Winters said. Doctors need better tools to help them sift through all that data "to ensure we're not ruling out potential diagnoses."

For the study, published online in BMJ Quality & Safety, researchers reviewed studies of 5,863 autopsies used to detect diagnostic errors in adult ICU patients.

Among their findings:

• Four medical conditions were most commonly misdiagnosed: Heart attack; pulmonary embolism (artery blockage in the lungs); pneumonia; and aspergillosis, a fungal infection that most commonly affects those with a weakened immune system. These four conditions accounted for about one-third of all illnesses doctors failed to detect.
• More than one in four patients had at least one missed diagnosis at death.
• Serious errors in 8 percent of patients may have either caused or directly contributed to the individual's death.
• Infections and blood vessel blockages, such as heart attack and stroke, accounted for more than three-quarters of what the researchers termed "fatal flaws."

Some suggestions on how to avoid misdiagnosis include keeping detailed records and asking the right questions.

In other health news:

Yosemite warns visitors of lethal rodent-carried disease. The Associated Press reports that Yosemite National Park officials are warning visitors about hantavirus, a rodent-borne disease that killed two park visitors this summer following overnight stays in the park's rustic tent cabins. On Tuesday, park officials sent letters and emails to 1,700 visitors who stayed in some of the dwellings in June, July and August, warning them that they may have been exposed to the disease.

MRI scans may be safe for people with pacemakers.  A new study adds to growing evidence that MRI scans may be safe for people with pacemakers or implanted defibrillators, Reuters reports.

Dental coverage for adults on Medicaid slashed. Banned from tightening Medicaid eligibility rules, Republican- and Democratic-controlled states alike have instead cut costs by reducing or largely eliminating dental coverage for adults on Medicaid, the shared state and federal health insurance program for poor people, The New York Times reports.

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