Several Groups ‘Deeply Concerned’ About AHRQ’s ED Diagnostics Report

By Jonathan Springston, Editor, Relias Media

A group of emergency medicine organizations issued a letter about a federal report they believe “makes misleading, incomplete, and erroneous conclusions” regarding diagnostic errors in U.S. emergency departments (EDs).

In “Diagnostic Errors in the Emergency Department: A Systematic Review,” the Agency for Healthcare Research and Quality (AHRQ), part of the Department of Health and Human Services, estimated among 130 million annual ED visits per year, 7.4 million (5.7%) patients are misdiagnosed, 2.6 million (2%) experience an adverse event as a result, and about 370,000 (0.3%) suffer serious harms from diagnostic error.

AHRQ studied data from PubMed, Cumulative Index to Nursing and Allied Health Literature, and Embase collected from January 2000 through September 2021 regarding “diagnostic errors or misdiagnosis-related harms in EDs in the United States or other developed countries with ED care deemed comparable by a technical expert panel.” Among almost 280 studies and more than 19,000 citations, the authors identified 15 conditions associated with serious misdiagnosis-related harms, including stroke, myocardial infarction, and aortic aneurysm.

The agency reported variation in these error rates, noting the inconsistency in how facilities measure diagnostic errors. “The strongest, most consistent predictors of ED diagnostic error were individual case factors that increased the cognitive challenge of identifying the underlying disorder, with nonspecific, mild, transient, or ‘atypical’ symptoms being the most frequent,” AHRQ explained.

Researchers noted there were limitations to their work related to data sources, measurement methods, and causal relationships. “New studies should confirm overall rates are representative of current U.S.-based ED practice and focus on identified evidence gaps (errors among common diseases with lower-severity harms, pediatric ED errors and harms, dynamic systems factors such as overcrowding, and false-positives),” AHRQ offered.

The American College of Emergency Physicians and other emergency medicine groups took issue with four key areas of the AHRQ report: the depiction of U.S. emergency medicine, the relevance of references, the interpretation of malpractice data, and the 5.7% figure. The letter authors requested some report revisions, including a description of the nature of emergency medicine in the executive summary and the removal of malpractice data. They also suggested removing the 5.7% figure.

“We also are deeply concerned that publishing this faulty document would have negative implications for both our current workforce and our future pipeline of emergency physicians, as well as the millions of people who seek emergency care in the U.S.,” the letter reads. “We understand and agree that there is room for improvement in the diagnostic accuracy in emergency care, just as there is in all specialties. All of us who practice [emergency medicine] are committed to improving care and reducing diagnostic error. However, we also believe the potential unintended consequences of the report, as drafted, inappropriately take aim at a standard of care designed to stabilize and treat the undifferentiated patient in times of an acute emergency.”

For more on this and related subjects, be sure to read the latest issues of ED Management and Healthcare Risk Management.