Burden of serious harms from diagnostic error in the USA, 2023, Siegal et al

Burden of serious harms from diagnostic error in the USA
https://qualitysafety.bmj.com/content/early/2023/07/16/bmjqs-2021-014130

Ironically, BMJ, a major contributor of diagnostic errors. But then so is pretty much everyone, it's systemic failure so everyone is complicit in one way or another.

Background
Diagnostic errors cause substantial preventable harms worldwide, but rigorous estimates for total burden are lacking. We previously estimated diagnostic error and serious harm rates for key dangerous diseases in major disease categories and validated plausible ranges using clinical experts.

Objective
We sought to estimate the annual US burden of serious misdiagnosis-related harms (permanent morbidity, mortality) by combining prior results with rigorous estimates of disease incidence.

Results
Annual US incidence was 6.0 M vascular events, 6.2 M infections and 1.5 M cancers. Per ‘Big Three’ dangerous disease case, weighted mean error and serious harm rates were 11.1% and 4.4%, respectively. Extrapolating to all diseases (including non-‘Big Three’ dangerous disease categories), we estimated total serious harms annually in the USA to be 795 000 (plausible range 598 000–1 023 000). Sensitivity analyses using more conservative assumptions estimated 549 000 serious harms. Results were compatible with setting-specific serious harm estimates from inpatient, emergency department and ambulatory care. The 15 dangerous diseases accounted for 50.7% of total serious harms and the top 5 (stroke, sepsis, pneumonia, venous thromboembolism and lung cancer) accounted for 38.7%.

Conclusion
An estimated 795 000 Americans become permanently disabled or die annually across care settings because dangerous diseases are misdiagnosed. Just 15 diseases account for about half of all serious harms, so the problem may be more tractable than previously imagined.

 

It's missing pretty much all morbidity from discriminated chronic illnesses so, yeah, way larger. If they can miss so many dangerous diagnoses, and we know they miss over 90% of some chronic illness diagnoses, it's probably several times larger.

And definitely not unique or particular to the US. I'd even suggest it's better over there in terms of diagnosis, since the US is one of the only healthcare systems where patients aren't stuck with whoever they are assigned to. Treatment is a different matter, diagnosis is likely far better over there than elsewhere, but refusal to diagnose leads to the exact same outcome.

 

I lost three years of my life because I had ME without knowing it, because doctors wouldn't diagnose it. I discovered ME by a Google search.